Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional Helpers OR From Empathy Fatigue to Empathy Resilie

1. Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional HelpersORFrom Empathy Fatigue to Empathy Resiliency Mark A. Stebnicki, Ph.D., LPC, CRC, CCM Professor, Dept. of Rehab Studies East Carolina University www.ecu.edu/rehb

2. The More We Stress Together… • There are discrete, basic, and universal emotions that persons react to on a Mind, Body, & Spiritual level. • Emotions involve different body systems which arouse our parasympathetic and sympathetic system. • Chronic activation of the nervous system (stress response) has both a physiological and emotional cost. • Cumulative effects of multiple client problems lead to a deterioration of the professional’s coping skills and resiliency skills- esp. if symptoms go unrecognized.

3. A Paradigm Shift in Mental Health and the Allied Helping Professions • Horrific terrorist attack Sept. 11th (2,996 deaths) • War in Iraq (4348 Am Military casualties) Afghanistan (796 Am); 84K Iraqi Civilian deaths (320,000 AM TBI) • Tsunami December 26th 2004 (275,000 deaths+) • Hurricane Katrina 2005 (70 deaths +) • Child Deaths (intentional-unintentional) by gun violence (3,024 deaths/yr) • School shooting deaths (323 deaths ‘92-’2007) • 4.2 mil worldwide living with AIDS • 3.1 AIDS-relates deaths

4. Fire Flood Hurricanes/Tornados Ice storms Plane crashes Volcanoes Earthquakes Epidemics Workplace violence Traumatic injury in the workplace School shootings Bioterrorism Transportation Accidents Civil Unrest Etiology of Disaster

5. Native American Teaching “Every time you heal someone, you give a piece of yourself away, until at one point you will need healing yourself” * Shaman or Medicine Man/Woman in many indigenous cultures understood that in healing practices the healer sometimes must takes-on the pain and suffering of others while planting the seeds for transformation. * Each personal transformation should bring about the necessary experiences for handling the next crisis so the mind, body, and spirit can be transformed.

6. Empathy Fatigue (EF) “ A dynamic state of physical, psychological, emotional, social, occupational, and spiritual exhaustion that occurs on a continuum, resulting from the helpers’ own wounds that are continually revisited by their client’s life-stories of chronic illness, mental/physical disability, trauma, grief, and loss.”

7. Empathy Fatigue Reactions and Impaired Professionals • APA – Impaired Professionals • AMA- “Physician Impairment”: “physical, mental, and behavioral disorder that hinders the physician’s ability to safely treat pts.” • ACA- Task Force on Counselor Wellness and Impairment • American Nurses Association

8. Theory of Empathy Fatigue • Persons who work in “high touch” professions are more vulnerable than those that don’t… • A natural artifact of working with patients that have intense acute and chronic physical conditions, mental health, and behavioral issues. • Many times an unconscious process where the professional and those around them may not recognize. • EF is cumulative and ranges on a continuum of low, moderate, and high levels of physical-emotional-mental spiritual, and occupational exhaustion.

9. Peripheral/ANS: Sympathetic-Parasympathetic Nervous

10. The Neuroscience of Empathy Fatigue: Our Emotional Brain • There are discrete, basic, and universal emotions that persons react to on a M-B-S level; • Emotions involve different body systems which arouse our parasympathetic and sympathetic system; • Chronic activation of the nervous system (stress response) has both a physiological and emotional cost; • 80% of all physical illness is cause by stress (Kabit-Zinn, 1990; Sapolsky, 1998; Selye, 1976; Weil, 1995)

11. Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases, and CopingDr. Robert M. Sapolsky

12. Q. Why Zebras Don’t Get Ulcers Answer: Zebras don’t have cumulative stress “If you constantly mobilize energy, You never store it; Your muscles waste away; Your vascular system is under constant pressure; and constant Cortisol production turns off growth factors and can harm every system in the body…”

13. The Cost of Being a Stressed Professional A study of 27,000 people in 50 different countries found that people with significant stress levels DOUBLED THEIR CHANCE OF HAVING A HEART ATTACK (2004 Interheart study with 50 participating countries)

14. The Problem with Too Many Unhealthy Thoughts, Perceptions & Feelings: Empathy Fatigue!!! • Excessive, recurrent, and intense emotional arousal; • Repeated reactivation of our perceptual-cognitive-affective response; • Stored unhealthy thoughts, perceptions, and emotions, become a worn neural pathway which leaves an imprint on our cognitive unconscious and causes a mind-body interaction.

15. Hindu Parable: The Monkey and the Banana

16. Critical Pathways • EF has both an acute, chronic, or delayed onset reaction that ranges on a continuum of low, moderate, and high; • Communication (verbal/non-verbal) that is exchanged between clients/patients and professionals during therapeutic interactions are integrated in the professional’s thoughts and feelings and becomes associated as a physical-emotional reaction

17. The Nature of the Helping Profession • Requires facilitating empathic approaches, cultivating client connections and relationships where we must attend, listen, act empathically to help our clients unfold the multiple layers of their stress, grief, loss, or traumatic experiences by searching through their emotional scrapbook. • The search for personal meaning and purpose of our client’s pain and suffering may contribute to the helper’s spiritual fatigue experience. • If professional helpers are mindful of this experience, and view this as an opportunity for nurturing personal growth and development, then they will learn resiliency strategies that can help to replenish their wounded spirit.

18. Share Your Experiences as a Professional Helper • How did youchose the helping profession? • In what ways are you encouraged or discouraged by your clients’ successes or failures? • How is your mind, body, and spirit most affected by intense interactions with others? • Describe any self-care you do and how you cultivate resiliency?

19. EF: A Combination of other Professional Fatigue Syndromes • Countertransference: the unconscious absorption of the patient’s issues, involves a type of symbolic or parallel experience of emotional button-pushing. It results in a sense of anxiety, stress, sense of loss, grief, and over-identification w/pt. • Compassion Fatigue: An acute stress reaction unhealthy form of countertransference results from emotional, mental, and physical exhaustion.

20. Professional Burnout A negative shift in the way professionals view people they serve. A cumulative emotional exhaustion, depersonalizaiton, feelings of a lack of personal accomplishment resulting in a loss of compassion, genuineness, and concern for the patient.

21. Signs of Burnout Feeling ….. Tired and out of energy Worthless Emotionally out of control Constantly negative thinking Alone and disconnected Depressed Stressed Anxious Substance abuse-addiction

22. Summative Philosophy of EF It is not necessarily the nature of the client’s stress, trauma, loss, grief, daily hassles, coping, or disability adjustment that creates a sense of EF for the professional; rather it is the professional’s perception towards that particular client’s; and the helper’s personality traits, states, and behavior that determines the response; which is determined by multiple factors that lead to a diminished capacity to listen, respond empathically, provide competent professional services…

23. EF Risk Factor Functional Assessment • Personality Traits • History of MH Problems • Maladaptive Coping Behaviors • Age and Experience-Related Factors • Organizational Factors • Job Duties within the Organization • Socio-Cultural Factors • Person’s Response to Past Events • Level of Support

24. Empathy Fatigue Resiliency Quiz1= not true of me….5=exceptionally true of me As a professional helper I perceive myself to be… • Resilient, adapt quickly to new client issues as they arise, and good at bouncing back after listening, attending, and responding empathically to my clients’ stories all day. • Optimistic, perceive that my client can increase their level of adaptive functioning regardless of how difficult their issues are, and I anticipate that things will turn out well for them. • Calm and focused while my client’s life is in crisis. • A good problem-solver by facilitating appropriate interventions by empowering my client with good resources. • Able to trust my clinical intuition and facilitate creative solutions to my client’s stressful life-challenges.

25. Resiliency Quiz (continued) 6.Self-confident, optimistic, enjoy healthy self-esteem, and have an attitude of professionalism about my work. 7. Playful, humorous, have the ability to laugh at myself. 8. Curious, facilitate good interventions, have a desire to understand how things work in my client’s life, and consult with others when I need help. 9. Constantly learning from my past mistakes during therapy and from the mistakes that I see others make. 10. Flexible, and feel comfortable with things that are somewhat complex in my client’s life, and can adapt to various client behaviors and personalities.

26. Resiliency Quiz (continued) 11. Able to anticipate when my client will develop specific problems and I have confidence that I will know how to deal with the unexpected. 12. Able to personally deal with my client’s negative or dysfunction life patterns and the ambiguity or challenge this presents in my own life. 13. Non-judgmental, a good listener, possess good empathy with my clients, express my feelings and be able to “read” other people well. 14. Able to recover emotionally from my client’s losses and setbacks, and let-go of negative feelings that I may have and how to ask others for help.

27. Resiliency Quiz (continued) 15. Durable, keep on ticking after tough client sessions and possess a balanced and healthy fighting spirit. 16. Stronger and better after facilitating interventions with difficult clients issues. 17. Able to discover some meaning in my own life at the end of the day, even after hearing multiple client stories of stress, trauma, addiction, anxiety, and depression….

28. Empathy Fatigue Resiliency Quiz Scoring 75 + = Very Resilient!! 65-75 = Resilient more than most helpers. 55-65 = Slow to rebound- but adequate. 45-55 = Whoa- I’m struggling as a professional. 45 or less = Leave now and seek help!

29. The Resiliency AdvantageDr. Al Siebert 1. Making conscious choices in life. 2. Power of Positive Thinking. 3. Take responsibility. 4. Internal locus of control. 5. Self motivate yourself. 6. Don’t fear trying-out new things. 7. Take control of your life. 8. Practice positive approaches to life.

30. Cognitive Signs of Distress Loss of concentration, lack of focus Apathy, lacks meaning in chosen profession Preoccupation with avoiding job tasks

31. Emotional Signs of Distress Feelings of exhaustion, lack of energy, sleep problems Emotional roller coaster of highs and lows, feelings of being overwhelmed Irritability, agitation, anger, resentment, isolation, detachment

32. Signs of Behavioral Distress Being on edge, very impatient Feeling extremely cynical, bad sense of humor Changes in eating and grooming habits, poor lifestyle management

33. Signs of Physical Distress Stomach aches, Headaches Shallow breathing, rapid pulse, heartbeat Increased illnesses due to lower immunities

34. InterpersonalSigns of Distress Withdrawal from colleagues Projection of anger or Blame, increase in inter- personal conflicts Poor communication skills with family, personal relationships

35. SpiritualSigns of Distress Loss of meaning and purpose with self and career Decrease in spiritual and religious activities Loss of faith in higher Power, cynical with past faith and beliefs

36. Signs of OccupationalDistress Decrease in quantity and quality of work Low motivation, avoid job tasks, increase in absenteeism Increase in mistakes

37. Case Illustration of Mental Health Professionals “While we were in counselor training, we were always told to “be competent professionals.” No one ever said exactly what that meant, or how to be a mental health professional. I guess we thought it meant being cool and calm under pressure, objective with our clients, and not to get easily rattled by “crazy persons.” But I did get rattled and upset at times- like the first time a client attempted suicide. Somehow I felt responsible and felt a mix of anxiety, anger, and sadness but I would be fighting any expression of those feelings to my colleagues because I knew that this was not the “professional thing to do.”

38. MH Professional{continued} “Everyone else seemed to be handling things okay, which made me feel even worse- like a real failure- like someone who wasn’t cut-out for this kind of work. I didn’t dare say anything for fear people would see out how weak I really was. It wasn’t until much later in my career that I discovered that most everyone else was just as scared, sad, and angry as I was when it came to persons who have chronic and persistent mental health issue are those who have be traumatized”

39. Show-up Pay Attention Be Open to the Outcomes

40. Solution-Focus Prevention • What would this problem situation look like if you were managing it better? • What changes in your present situation/life would make sense right now? • What would you be doing differently with your problem situation if you were to make the changes you wanted to make? • What things have you thought about that would make life better for you right now? • What things/feelings in your life would you like to eliminate right now? • If you eliminated certain things in your life what would that feel like? • When do you plan on making these changes?

41. The Critical Stress Factor in Disease: Optimizing the Healing System {Dr. Weil} Lack of Energy Poor Circulation Restricted Breathing Impaired Defenses Toxic Overload Age Thoughts, Perceptions, Cognitions Spiritual Problems

42. The Organization’s Responsibility in Wellness • Skilled & Competent clinical supervision • Mentoring approaches • Peer-supervision • Shift focus of treatment team meetings • Re-structure organizational philosophy to a healthy person-centered wellness

43. Expression of FeelingsExpressive Drawing “Emotional Landscape”

44. Journal Writing Spontaneous writing (dreams, fantasies) Open and honest Accept whatever comes to mind Grammar- spelling fagetta-bout-it Process is just for You

45. Reducing Workplace Stress: It’s 15% Effort, Productivity, and Showing-up - 85% Attitude! • Wake up and affirm that you have a job (15.1 mil Americans or 9.8 are unemployed) • Leave your house with a heart full of gratitude (may require some morning ritual) • Recognize the range of opportunities and be open to all the possibilities that your employment brings • As you travel to work be aware of how you cultivate-prepare your mind, body, and spirit for your profession • While at work take a moment to be aware of how you are cultivating and preparing your m-b-s for your profession

46. Cultivating-Preparing M-B-S for Your Profession • Be mindful of the toxins you take-in your M-B-S • Lunch- an important part of your day- use it wisely • Be aware of how you communicate with others throughout your day (verbally and non-verbally) • Get good closure with people, job tasks, and organize yourself for tomorrow- leave your work personality and behaviors-at work • Get out of your work clothes immediately when you get home and allow yourself to transition into your home environment • Brrreeaatthh!!!