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Compassionate Professionais 1

Running head: COMPASSIONATE PROFESSIONALS

NON-VOLITIONAL WAlRMENT AND RESILIENCE IN COMPASSIONATE PROFESSIONALS:

A MODEL

A THESIS ÇUBMIITED IN PARTIAL FULFKLMENT OF

THE REQUREMENE FOR THE DEGREE MASEROF ARTS

in

THE FACULlYOF GRADUATE SWDIES

GRADUATE COUNSEZlUNG PSYCHOLOGY P R O G W

August 21, 2000

The role of ttte professional "people-helw offers no guatantee to its

praditioners of personal immun@ h m the dimuptions of life, whether

inconvenientiy minor or completely devastating. Life events sudi as

bereavement, failing health, changing rehtionships, andlor financial diff idt ies

are liMy to occur in everyone's life eXpenence at some point. This thesis focuses

upon the experience of the "compassionate professional" encomtering life

events which are disnipave in the extreme - particuLarly conditions and

experiences that are best descriid as random, adverse, a d pemnally

catastrophic. C m t l y available professional impairment literahw indicates

that scant attention has been directed toward the realities of these non-volitional

stressors, and potential resolutions, espeoally among clergy and cou~lsellors.

This Uiesis synthesizes existing models of resource-congruent coping (Wong,

1993) and compassion fatigue (Figley, 1995), creating a theoretical hamework in

which to explore issues of the compassionate professional's +ence. The

mode1 includes: (1) speQfic culhial context (the unicpe influences shaping

professional subcultures pafticular to Christian minisbiy and pmfessional

caregiving); (2) integrated appraisal (a position focuseci on the hannonizing of

personal and professional d e s durhg the eXpenence of significant random Me

disruptions); and (3) the loas to growth spectnim rdecting directions of

po tential outcornes (threshold of stability / instability, compassion fatigue, and

compassion resilience). The focus of this thesis is upon the influence of non-

volitional disruptive events in both the private and vocational life of the

compassionate professional, with an emphasis upon global proases rather than

selecüve mechanisms m the sphere of the integrated appraisal and coping.

Table of Contents

Abstra ct .............................................................. i Table of Contents ..................................................... ii

Acknow1edgements and Dedication ..................................... v

Chapter One: SETTING THE CONTEXT ................................. 7

introduction ................................................... 7

Parallels Beîween Pastoral and Counseilor Roles .................... 8

The Wounding of the Healers ................................... -10

Distinctions Between Compassion Fatigue and Bumout ............. 12

Definhg the Compassionate Professional .......................... 15

Chapter Two: PROFEÇGIONAL IMP- ABRIEE: LITERATURE REVIEW ..................... 20

Introduction ................................................... 20 ................................... Impainnent Issues in Medicine 20

Impairment Issues in Nursing ................................... 23

The Perspedive of M a l Work .................................. 24

Pastoral Impairment Issues ...................................... 26

.......................... Impairment Risks Aaoss the Professions 30

Narrowing the Fanis of the Impairment Literature ............... -31

............................. Defming Non-Volitional Impairment 33

Nomvolitional Impairment and the Psychoanalytic PerSperave .... -33

Ernpincai Investigations of Non-Volitional Professional Impairment . . 36

Chapter EXIÇIWG MODELS .................................... 51

Compassion Fatigue: A Background ............................ -51

A Model of Compassion Stress and Compassion Fatigue ........... -53 .................................. A Mode1 of Congruent Coping 58

................. Case Applications of the Wong and Figiey Models -61

Chapter Four SOURCE MODELS BLENDED AND ElCïENûED ........... 68

Brief Rinaples of Theory Development ........................... 68

The Path of Theory Development Toward the Synthesized Mode1 .... 68

....................................... Redience Mefly ûefined 72

Wong and Figley Interpreted Through Case Materials ............. -75 Non-Volitional Impairment and Resllience in Cornpassionate

......................................... Professionals: A Model 80

.................................. SpeQnc Culturai Context 81

.......................... Congruent Resources Repertoire 83

Secondary Traumatic Stress. Prolongecl Exposute and .................................. Traumatic Recollections 84

........................... Non-Volitionai Life Disruption -86

............................ Revious DysfunctiOnaj Coping 89

..................................... Integrated A* 92

...................................... Inteptecl Coping -92

............................ Ineffective/ Inadequate Coping 94

Summary of the Mode1 .................................... 99

Chapter Five: CONCLUSIONS. WLICATIONS AND APPLICATIONS ................................... 102

A Brief Review .............................................. -102 nie Necessity of Practicai Applications ........................... 105

Identifymg Potentiai Appîïcations and Challenges ................. 106

A Final Word ................................................. 110

Figures ............................................................ -126

Figure 1 . Compassion Stress (Figley. 1995) ...................... 126 Figure 2 . Compassion Fatigue (Figley. 1995) .................... 127

Figure 3 . Resource-Congruent Effective Adaptation (Wong, 1993) . 128 Figure 4 . Non-Volitional Impairment and Resilience in

Compassionaie Rofessionals ........................ -129

Appendix .......................................................... 130

Case 1: Louisa. a Mental Health Theapist ........................ 130

Case 2: Pastor Craig, a Patish Pastor ............................. 134

Case 3: Richard. a Student Services Courrsellor .................... 138 Case 4: Katnona. a Private Fractitionet ......................... -143

Chapter One

SEl7lNG TIIE CONTEXT

Introduction

There is a certain irony in the realization that pastors and counseilors - people who provide care and support to others through some of life's most

intimate and painhil moments - are themselves often emotionally isobted

figures (Herlihy, 1996; Hickson, Gudz Q Hombuckie, 1995; McBurney, 1986;

Wamer Q Carter, 19û4; Morris & Blanton, 1994; Owen, 1993; Coster 6r Schwebel,

1997; Nouwen, lm). Pubiidy identifieà with images of ideal spiritual, emotional

and mental health, in private they are as M y as anyone to d e r h m the

blows and discouragements of human existence, including relationships that

confiict and cmmble, health that becornes fragile, addictions that grow, finances

that wither, aspirations that flounder, and deaths that t h dose to the heart. In

circumstances of such intense persona1 distress, members of these two related

"compassionate pfessiow" may nevertheless feel enormously pressureci to

maintain a stoic and seif-contained profesional posture, knowing full well that

private life Win be subject to public scrutiny.

Given the l ikelihd that any of these ernotionally weighty conditions

could affect the Me of any person, at any tirne, it is significant to note that the

existence and potential ramifications of such "non-volitional impairments"

remain an area relatively unexplored within the body of professional

mipainnent literature. It is the intention of thîs discussion to address some

Mted aspects of this void, particularly those concemed with the experiences of

counsellors and derics who enanmiter unavoidable cimunstances of peRonal

catastrophe and potential Unpairment.

Warner a . Carter (1984) discuss issues of tension between the public

persona and private reality in the pastoral experience, describing a commonly

held perception of dergy and th& famicies as "community caretakers,'' whose

every Life experience is subjed to dose inspection by the people to whom they

minister, for signs of success or failure. Wnhg hom a Roman Catholic

perspective, Hickson, Gudz and Hombuckle (1995, p. 35, c ihg Bowers, 1963)

comment that the pastoral &g has haditionally carrieci an "insurmountable

contrast between [the] very real humanity and the transcendent requirernents of

[the] symbolic representation [of] the @est." Kennedy, Eckhardt and Goldsmith

(1984, p. 17) offer a similar observation, noting that "...congregational members

expect their leaders to perform, respond, and act in a manner after which they

rnay pattern their own lives." In an empùical study whkh paralleis Kennedy et

al. (lm), Blackbitd and Wright (1985) report that the derical eXpenence is one in

which pastors feel th& vocation o h causes them to be "placed on a pedestal",

preventing them h m enjoying sponhneity of personal expression, behaviow

and relationships, regivdless of th& personai needs. Moms and Blanton (1994)

report a similar finding, noting that a fiquent companion to the pastoral role is

an içolating "celebnty-like status" for both the individual deric and his/ her

family, an extemai perception whidi mates challenges and diffidties in the

formation of intimate relatiomhips (e.g., Iriendships) outside the family W e .

The expectations held by other people conceming a cOUIISellor's approach

to the vicissitudes of life may be equally idealistic. 'Invincible", "invulne2abIe",

even "omnipotent" are among the qualities frequently ascribed to therapists in

the perceptions of their clients (Counseiman & Alonso, 1993; Gold, 1993; Daines,

Gask k Ushmood, 1997). S i l y I a sense of quasi- "Unm~rtality'~ may

v a d e the counsell~~-ciient relaticmship. According to Simon (1990, p. W), the

existence of the therapeutic union indudes a taat assumption that the coullseUor

will always preserve that d e , unaitezed by time or cimmstance and, without

question, will "outlive the treatment and continue to be avaüable indefinitely ." Most commonly, the therapist seems to be considered as a mode1 of what the

dient wishes to become in terms of adjushnent, coping, behaviour and

emotionai health (Schiachet, 1996). The counsellor's experience with personal

crisis carries critical weight, then, in the treahnent and progiess of the client,

since "the therapist's responses and reactions affect the psychotherapy

relationship and process. Both therapist and patient are unavoidably touched by

a signiticant ocamence in the therapisfs Me," (Sion, 1990, p. 590, emphasis

added). Pope and Tabadinick (1994) lend support to this observation, noting

that the psychoanalytic orientation has traditiohally aclcnowledged a concern

that the analysYs personal Me experiences, if unadàresseâ, may become

detrimental to the pfactice of effective therapy.

It is in this realm of tension, between a real and falliile human existence,

and the pedestall target occupid by the professional role, that the pastor and

therapist dwell. It is a problem that fresuently exists unnoticeci, unaddresseci,

and unresolved until the advent of a cri& in the congregation, counselling

pradice, or petsonal life of the individuaL professional. In some instances, this

crisis rnay become apparent in the exhaustion of "burn-out" (W~tmer & Yaung,

1996; Emerson 6r Matk~s, 1996), a disabling depliession (Emerson 8 Markos,

1996; Muse br Chase, 1993; Raybum, 1991), or serious issues of physical ill-health

%me ministem and counsellm, l i k many 0th- peoplef m o r t to dearly

dysfunctional stress reduction behaviours such as the abuse of alcohol or other

substances (Oisheski B Le& 19%; Emerson & Markf 19%), eating or

gambiing disordm (Hill & Baillie, 1993), inappropriate, risky and sometimes

criminal semai conduct (Alcom, 19%; Hopkins, 1991; McBmey, 1%;

McButneyf 1996; Steinke, 1989; von Shh, Mines B Anderson, 1995; Emerson &

Markos, 19%), or rigidly authoritative and othenvise exploitive power

relationships (Falbo, New 6r Gaines, 19û7; Emerson dr Markos, 19%). Several

researchers dkuss the complicated dyMmics of deception, of both the self and

others, Uiat becorne active when a member of the dergy maintains a dud life,

pu~lposefully engaging in such dysfunctionai behaviom (in theological temis,

those "volitional s i . ) that are in dear conflict with the pastoral role (Steinke,

1989; Fortune, 1989; von Stroh, Mines & Anderson, 1995). Commenthg from a

sedar perspective, Epstein, Simon and Kay (1 l982), and Webb (1997) offer

paralle1 observations regarding the influences of therapist self-awiueness and

self-deception in instances where the culmination of personal Srcumstances and

choice result in professional boundary violations against clients.

The Woundina of the Healers

For most members of these compassionate professions, however, the

greater burden of th& respecüve vocations is fou& not in the struggle to

maintain consistent authentiaty between public and private life, but in the

inherent expectation that they will provide a limitiess source of quality support

to o t k people dealing wïth M e demands; fiesses and addictions, deaths,

divorce, shattered d.amsf spintual searching and the myMd 0 t h prob1ems

defuiing the human condiaon. In a m e y of the extant literature regarding

pastoral hctioning and wd-be in~ Hall (1997, p. 240) broadly comments that

"there is neuer a thne when they are not on c d to fundion in their pastoral role"

(emphasis added). Kieren and Munro (1988) characterize the ministerkd d e as a

"greedy" one in the pastor's Me, demanding extremdy high rates of invatment

in tirne, emotion and other personal resources, o h to the detriment of

relationships with family and fnends. Morris and Blanton (1994) Lîkewise discuss

s e v d signiscant @lems encountered by detgy families, including excessive

tirne demands imposed by the ministry upon the derical member, fiequent

intrusions by the people and neeâs of the ministry into areas of the family's

privacy, and 0th- (albeit unintentional) boundq enaoachments. The research

ensemble Raybum, Richmond and Rogers (1988) offers much the same

condusion in a series of 17 brief shidies examinhg Levels of stress eXpenenced by

d e and female "rehgious pmfessionals", both mariid and single.

Commenting on the often poor definition of the role boundaries between "life"

and "work" for clergy members, Kunst (1993, p. 209) observes thak

unlike rnany professionals who are able to leave their

work at the office and maintain dear limits regardhg th&

private lives, artinisters are overly visii1e and available to

those whom they serve....their neighbours may be church

members, they kequently sociaiize with parishioners, and

their "days off are often intempted by emergency concerns.

P d e l observations have been made conceming the weariness that can

be inherent in the d e of the therapeutic professional. Figley (1995) identifies the

inaeasing oaYrrence among clinicians, particular1y those engaging in severe-

trauma work, of a phenornenon known as "compassion fatigue". Briere (19%)

makes simüar observationsp discussing at length eXpenences common to those

therapists who focus on healing work with SUNivors of sexuai abuse, induding

sociai and professiional isolation, prolongeci and repetitious exponve to homfic

materiai, and si@cant diçiuusionment with people and professionals in general.

Whether working with survivors of abuse or some 0 t h traumatic event, it

seems apparent that the very quality of ernpathy, whid\ is the C O U I ~ S ~ U O ~ ' ~ gift

and skill for this compassiortate vocation, can become the seed of his or her own

extreme distress. The danger, writes Figley, lies in the fact that "relief of the

emotional suffering of clients automatidy uidudes absorbing Uiformation that

is about dering. Often it includes absorbing that suffering itselfas weU" (1995,

p. 2, sic, emphasis added).

Dish'nctions Between Cornvassion Fatime and Buniout

Warranthg carehil attention at this point is a problem closely reiated to,

but distinct from compassion fatigue: that of therapist '%urnout!', as discussed by

several researchers (Ememn & Markos, 1996; Witmer & Young, 19%; Sowa,

May h Niles, 1994; Neukug & Williams, 1993; Reamer, 1992). Sowa, May and

Niles (1994, p. 19) write:

persans in occupations that involve providing Services

to others, such as c o d m , are especially vulnerable to

the accumulation of occupaticmai stress and subsequent

burnout The many dernands placed on c o d o r s ... and

the ethical dilemmas Uiheffnt in the counseling profession

... contribute to the occupational stress of counseling as a

profession.

While the concept of h o u t was first introduced in kterature specific to

public health and social service professions in the 197Vs (Hall, 1997; Witmer &

Young, 1996; Wamer & Carter, 19&), the term has become too frequently

misappptüited by the popuhr press, and mdiscnmina . . . M y applied in the

vernada.. A more accurate understanding may be gained from a bnef survey

of the multiple chical descriptors identitying bumout among professionai

caregivers. A function of the pressures involvecl in having too few resources

with whidi to meet too many demands, therapeutic bumout may be manifest in

any of the following:

a) a condition of chronic stress hom prolonged, demanding

and non-reciprocal interpersonal con tact (Hall, 1997);

b) an experience of "emotional exhaustion, negative

attitude shift, and sense of personal devaluation" (Patrick,

1981, p. 11, ated in Menningerf 19%);

C) ùicreasing Levels of intolerance for ambiguity, and

inflexicbility when confronthg new experierices (Owen, 1993);

d) a los of positive feelings regardhg the profession, and

a marked decrease in sympathy or respect for clients

(Witmer dr Young, 19%; Skorupa dr Agresti, 1993);

e) increasing physical or emotional efforts to "escapet' from

the therapeutic demands of the profession (for exarnple,

avoiding dient contacts or daydreaming in sessions) (Emerson

dt Markos, 19%);

f) severe procrastination and increased Cymcism, with a loss

of desire to help (Emerson & Markos, 19%);

g) inaeased physical arlments (Emerson & Markos, 19%);

h) substance abuse (Skompa 6 Agresti, 1993); and

i) contemplation or attempt of suicide (Pope 6r Tabadin*

1994; Reamer, 199î)J

Given that the current broad application of the tem bumout has

somewhat diminished its authentic diagnostic significance, Figiey (1995) takes

pains to delineate bumout h m the condition of secondary traumatic stress (STS,

also labellecl compassion stress), establishing them as qualitativdy diflerent

states, and not simply degrees of variation on a single distress spectrum.

According to Figley (1995), one of the differentiating factors is established by the

time Erame in which the two conditions develop. Hoff (1995) similar1y

dis~guïshes bumout from other aisis states, Q h g its chronic rather than acute

character as the measure of distinction. Bumout, then, is best d e s c n i as a

chronic condition, the end product of a slow erosion of emotional and other

tesou~ces, which is ody gradually manifest in the coping styles of the

compassionate professional. Converseiy, acute SE/compassion stress can

develop with little waming, in extremely qui& tirne, and in response to a

discrete event or series of events (Figley, 1995). Figley (1995) m e r notes that

SE/ compassion stress is characterized by a sense of imrnediate helplessness,

conhision and isolation not generally assOaated with the malaise inherent in

emotional bumout. Fïnally, according to Figleis (1995) assessment, bumout

1 It is beyond the scope of the piesent discussion to evaluate the psychological literature concerning suicide, and its reiation to bumout and other professional impairrnents. Howevet, given the recognition that contemplatedlattempted suicides greatly outnumber completeâ suicides in the general population, that contemplatedfattempted suicides are reported in relation to burnout syrnptoms, and that self-reporting of completed suicides is impossible, it may be reasonaçdy concluded that fully reaiized suicides are, at least oaasionally, the extreme outcome of the compassionate professional's bumout experience. For more speufii information, the intefested reaber shouid consutt the extensive suicide l i t m r e found in psychoiugy, medine, sciai mrrk, and oîher disciplines.

and 5TS/compassion stress are distinguished by the Pace of the recovery phase.

Typically8 compassionate pfessionals experiencing SE/ compassion stress

demonstrate a retum to previous leveis of well-functioning more swiftly than do

casualties of bumout (Figiey, 1995), an observation which pafalleis the sudden

onset of the trauma-related condition versus the slow deterioration of

developing burnout.

Definina the Comvassionate Professional

It seems apparent that by the very nature of th& roles within vocations

defined by compassion, pastors and counsellors bear a tremendous risk for

conditions of personal isolation and professional exhaustion. Understanding the

nature of the human phenornenon known as compassion is therefore essential to

understanding the professionai's experience with compassion fatigue. Nouwen,

McNeill and Morrison (1982, p. 4) write with simple clarity regarding the nature

of cornpassion in the human experience:

The word cmpmsion is derived from the Latin words pati

and mm, which together mean 'to d e r with.' Compassion

asks us to go where it hurts, to enter into places of pain, to

share in brokenness, fear, confusion, and anguish. Compas-

sion challenges us to cry out with those in misery, to moum

with those who are lonely, to weep with those in tears.

Compassion requires us to be weak with the weak, Yulner-

able with the vulnerable, and powerless with the powerless.

Compassion means full immersion in the condition of being

human. Whm we look at cmpadm this way, it becornes

or tenderheurtedness (emphasis added).

Cornnienhg on the dynamics of the counseiids acperience of

compassion, Owen (1993) considers the possiiility that many psychotherapists

ch- the profession, in part, seivching to hilfill unmet intinlilcy ne&, as a

reaction to Me-long ernotional isolation. Maeder (1989, ated in Milier, Wagner,

Britton 6t Gridley, 1998) o h a kmcired observation, stating that "the helping

professions, notably psychotherapy and the ministry, appear to attract more

than their share of the emotionally unstable wounded healers," (p. 37).

Roviding a balance to these somewhat negative perceptions is another portrait

of the "wounded healef' that emetges h m both the pastoral and therapeutic

literature (Gerson, 1996; Figley, 1995; Neukrug & Williams, 1993; Owen, 1993;

McBumqr, 1986; Nouwen, 19721 l979), whkh considers the güts of empathy and

insight bom of the professional's experiences with dfering. nie remainder of

the passage by Nouwen, McNeiU and Morrison (1982, p. 4) cauiters the opinions

of Owen (1993) and Maeder (1989, cited in Miller, e t al, 1998):

It is not surpriang U\at compassion, understood as suffering

with, often evokes in us a deep resistance and even protest.

We are inclineci to Say, ''This is self-flagellation, this is maso-

this is a morbid interest in pain, this is a si& desire."

It is important for ris to acknowledge this resistance and to

recognize that SUEfkring is not s r n e t h g we desire or to

which we are attracted. On the contrary, it is somelliing we

want to avoid at all cost. Wefore , compassion is not mnrmg

our tnost naturaf r We me pain-tmiders and we wnsider

anyonr whoférls atbacted to su@ig abnonnal, or at laast aery

unustuzf (emphasis addeci).

Finally, in language evocative of the existentialist miters, Miller e t al (1998, p.

125) offer a helpfd summary of the wounded heak concept:

The corisensus Mef is that the c d o r can b.anscend the

painful or tragic experiences of Me. This transcertdence allows

the counselor to bridge the conditions of mental health and

mental ihess, thereby bringing compassionate healing

to the therapeutic reiationship.

ui spite of this dose identification with the derings of others, there &ts

a profound imbaiance in the relational flow between compassionate

professionals and their clients or congegants, a pattern of 'W-intirnades"

(Kunst? 1993) that has received attention h m several researchers. Feelings of

lonelines, alienation and isolation are reportedy prevalent among reiigious

pfessionals of ail wallcs, inciudùig Roman Catholic priests and nuhs (Hickson,

Gudz & Hornbudde, 1995; Raybum, 1991). pastm amos a wide range of

Protestant denominations (Wamer C Carter? 1984), and women rabbis of the

Refonned movement (Raybum, Richmond & Rogers, 1988g dr 1988h). Hickson,

Gudz and Hornbztckle (1995, p. 37) hitther report that in the experience of many

Roman Cathoiic derics, "personal relationships with others are ordinarily distantf

highly stylized and often unrewarding."

Almost identical to KunsYs (1993) discussion of the half-intimacies in the

pastomte, Guy and Liaboe (1986) retum to the theme of imbaIanced

ielatimhips in th& description of the "me way intimacy" that is characteristic

of the traditional theapeutic alliance- Such a skewed pattern is not surpriPng in

a field where professional preparation and practice require the continual

examination of issues sumounding boundaries, non-disclœure,

countertransference, mnfidentiality, and appropriate pefsod/ professional

ethics. To paraphrase Kunst, (1993, p. 2û9), it seems evident that as praditioners

of the compassionate professicms, both dergy and therapists are expected to

engage in muitiple unidirectional relationships - wherein the participahg

"other" may disclose phenomdy personal feelings and needs - without

oppottunities for, or expectatiom of, 1Tecipmcal reveiatiorts by the pastoral

caregiver .

Sutnmal'~

In üght of such observations, it seems evident Uiat in the practice of these

distinctty "compassionate prokssions," certain conditions are consistent aaoss

the eXpenences of both counsellors and pastors. These observations may be

summarized by the following points: (1) that courtseilors and pastors occupy a

unique and highly presenued d e of trust and modehg in Society; (2) that they

are not immune to the experience of catastrophic or chronically debilitating

circumstances; (3) that poa judgment or delikate choices may significantiy

impact both petsonal and professional actions; and (4) that extrema of

emotional isolation are W y to occur over the course of the vocational Mespan/

often due to the expectations of the vocation. Given these realities, it is a matter

of fundamental importance to examine and understand the ability of the caring

professional to authentidy hindion in that d e while enduring his or her own

iïfe crisis (DeWaldB 1994; S i lm; Vamos, lm; Reamer, 11991; DiGiulio,

1997). An appropriate starting point for this sipifiant pursuit lies in the

exploratim of existing iiteratureB derived from various but compaable

professions, and patainllig to both broad and speQfic questions of compromised

pfessional functioning.

Introduction

Discussions of professional impainnent issues, incorporaporatug

circumstances and conditions, incidence and reporting rates, effects, treahnents,

and recidivism may be found in the îiterature of most disciplines of health care or

spintual leadership where the focus is upon "the care of persans," including

medicine and psychiatry, psychology, social work, nutSin& pastoral theology

and (most recently) counselling (Menninger, 19%; Olsheski & Leech, 19%;

Emerson & Markos, 1996; Re-, 1992; Kagel 6t Giebeihausen, 1992. Swenson 6t

Foster, 1995; Hoff, 1995; von Stroh, Mes 6t Anderson, 1995; McBumey, 19%;

Hazler & Kottler, 19%; Witmer & Young, 19%; Sheffieid, 1998). Whiie the

recognition of b o a actual and potential problerns of professional impairment is

lteQected in the ethical codes of rnust disciplines, working definitions of the

pmblem vary considerably (Kilburg, Nathan 6r Thomson, 1986; Emerson dr

Markos, 19%; Sherman, 1996; Sherman 6c Thelen, 1998; Sheffield, 1998).

Imvuhent Issues in Medicine

One of the earfiest efforts to defïne professional impairment in any field

appeafed in 1973, when the American Medical AsBodation's (AMA) Council on

Mental Health issueci its "si& doctor statutePm stating professional impainnent

was present when a physician was no longer able to practice "with reasonable

ski11 and safety due to ph* or mental disabilities Ulcluding deterimation

through the aging process or l o s of motor sk31 or abuse of dnxgs or alcohol,"

(Qted in von Stmh, Mines 6r Anderson, 1995, p. 7). By the late 19Ws, physicians

belonging to the AMA formally defined impaitnient in their Cield in the following

manner:

the Wity to deliver competent patient care r d t i n g

h m alcoholism, chernid dependency or mental lunes,

induchg h o u t or the sense of emotional depletion

which cornes h m stress, (Sbdler, Willing, Eberhage 6r

Ward, 1988, p. 258, cited in Emerson &c Markos, 1996).

6

Doctors in at least one Axnerican state presently adhere to an even more

stringent definition of physician impairment than the national standard

originating with the AMA. The North Carolina Physiaans Health Program,

legislatecl in that juridiction to identifjr and adcires incidents of professionaiiy

impaired practitioners, recognizes six spedic areas of concem: 1) alcoholism and

alcohol abuse, 2) 0th- dnig addictions, 3) sexual misconduct and harassment, 4)

psychiaûic disorders, 5) behaviowal disorders, and 6) conditions of dual

diagnosis (Sheffield, 1998). Eisewhere in the Literahw, BisseIl's (1983, cîted in

Sherman, 1996; and ated in Sheffield, 1998) consideration of chemidy

dependent doctors proposes a deat distinction tetween physicians who are

incompetent, those who are unethical, and those who are tnily "impaireci."

According to these guidelines, incompetency occurs where physich training

was inadeqpate andior continuing professional ducation is lacking; unethicd

professionai behaviout is dernonstrateci where the physicïan is dishonest, or

uncaringf negiectful of appropriate patient care; impaireci functioning ensues

where the doctor in question is ill, whether the condition is one of alcohoüsm,

mental ihess, or a disease h m which recovery is unlücely ( B M , 1983, Qted in

Shetman, 19%, and cited in Sheffield, 1998). Sherman (19%) points out that

Bissell's categories are "non-mutudy exdusive" and contain brwd degrees of

impairment. Such an observation concedes both the Likelihood that multiple,

complicated sources may contircbute to a professional's impaired condition, and

that the judgment of "impaimient" in any given situation is, frequently, a

subjective one. This recognition bears signifiant implications for issues of

intervention, treatment, and the ethical responsib'ities of colleagues when a

professional is suspecteci or found to be impaired.

A similar observation is advanced by the British Columbia College of

Physiaans and Surgeons. According to the Registrar of that body at the time of

this writing (PXebùecis, personal conununication via electronic mail, A N 2 7

1999), the mdtiplicity of potential sources of professional impairment predude

the utility of a singleI pr& dennition Instead, the CoUege focuses its efforts

upon educaüng its members and the puMic regarchg practitioner distressI

idenmg individuai cases of impairment, and the devebpment and

implementation of appropriate interventions, such as the Physician Support

Rogramme (P. Rebbeck, personal communicaticm via dectrwiic ma& April27,

1999). This approach se& to emphasize a partnership between the regulatuig

body and the physich-at-risk in the management and resoluticm of the

impairing arnimstances, before resorting to potentially invohntary (and

necessarily severe) interventions allowed for by provincial legislation. At this

date, the Colleges of Physicians and Surgeons in most Canadian provinces

e x h e a similar a p c h to problems of impairment within theV profession

(P. Rebbedc, personal communication via ele-ctmmîc mail, Apni 27,1999).

Registered, licensed and practicai nurses comprise a segment of the

medical establishment distinct hom, but dosely aligneci with the professional

commUNty of physicians and surgeons, resulting in a professional nursing

culture shaped by many of the same conditions and pressures. It follows, then,

that nurses are like1y candidates for impairments similar to those mentioned by

the AMA, and exp10red in relateci literature. Proof of this expedation is borne

out in the exisüng Merature's toais on addictions-related impairments within the

nursing profession (Hoff, 1995). Although precise enmerations of those

functionally impawd or "al-risk" nurses are unknown (Swenson & Foster, 1995),

Anderson (1994) reports that the incidence of chemical dependency among

nurses occurs at a rate of more than twice that found in the general population.

In the US., severai programmes currently emSt for the intervention, treatment

and support of nurses admitting to (or found to have) dru6 alcohol and other

substance abuse problems (Anderson, 1994). In a m e y of the complicated

structures of Arnerican xnalpractice insurance coverage as it Çpecificajly relates to

impairment within the nursing profession (Swehson & Foster, 1995), the

majority of the literature documenteci also indicates a focus in this field on issues

of mental illness, chernical dependency and other substance a h among

nurses.

Finally, related issues of impaved cornpetencies and abuses of power

within the nursing field must be consideted. It has been noted that both public

and professional awareness of "inappropriate nurse-client relatianships has

grown as an issue over the pst kw years" (Canadian Nuses Association, 1998).

A recent domment, jointly issued by the three nursing regulatory organizations

of British Columbia (Registered Nurses Assoaation of British Columbia,

Registered Psychiatnc Nurses Assoaation of British Columbia, k British

Columbia C o d of Licenceci Practid Nurses? 1995) addresses these issues with

the use of "plain-languaget' ethics, disamion-provoking scenarios, and

suggestions of proactive and preventative measures for use by nurses in self-

evaluation.

The Perspective of Social Wmk

in a discussion of the known impainnent and treahnent rates among

professional social workers, Reamer (1992) proposes three sources of impairing

"interference," deriveci fiom work by the research ensemble of Lamb, Ressert

Pfost, Baum, Jackson and Jarvis (1987):

a) an inabïLityI or disinchation, to acquUe and integrate

acceptable standards of behavi0u.r in the professional hction;

b) an inability, or disinclination, to develop professional skiUs

to an acceptable levei of competency; and

c) an Mbility, or disinclination, to manage elements of personal

Me (inciuding stress? psychologid dysfwicüon or extreme

emotional reactions) that may interfere with competent

professional functioning.2

The third b u e rdected in Remefs (1992) discusçim is ampLified in

DiGiuliors ((1995) brief study conceming workplace responses to M d welfare

worktm who experience sipficant emotional losses, either personal or

2 This third area of potentially impairing condiions described in FFeamer's (1992) anaiysis of social workefs, generalty describlng circumstances of extemal, adverse, signifïït and frequentty unavoidabk stressos. 's orie patimibrly relevant to the present examinatkn of random crises and non- w o W i inyminnent or resiliemt ammg c o ~ i o n a d e pr&?ssbnak.

Cornpassbnate Profession J s 35

professional. Reamer's (1992) discussion, dortunately, conveys the impression

that, in order for social wmkers to remain unimpaireà and hee of interferhg

emotions, distresshg personal events may (and shodd) be reduced to elements

simply in need of effective "management". However, DiGidio's (1995)

definition of these losses recognizes the profound depths of some human events,

and anticipates the present definition of potentially impairing nomvolitional

stressors among compassimate professionals. She writes:

For the purpose of this research, loss was defineci as the

ending of an important relationship because of death, divorce

or marital dissolution; [the] illness or disabüity of the M d

weifare worker, a family member, or a close fnend; and

the LMnad or emotional crisis of the diild weLfare worker,

@iGiuiio, 1995, p. 880).

Given this definition. it is interesthg to note that the majority (85%) of

DiGiulio's (1995) sample of 106 professional child welfare workers reported

telatively recent, and frequently multiple experiences of serious pefsonal Loss.

Two-thirds had sullered the death of a loved one, two-füths reporteci dealing

with serious illness or disability in family or aiends, and signiscant emotional

losses resuiting h m pe.rsonal experience with ïllness/injury were acknowledged

by more than a thid of the samp1e group (DiGiulio, 1995). The dissolution of

marriages or oher signiscant relatiomhips, financial crises, and undehed

emotional crises? while reporteci by fewer of the sociai workers inDiGiuiio's

(1995) study (between 16 and 26%), were also rmbstantial sources of respondent

distress. The implications of even this limiteci investigation are sobering.

Examinhg DiGiulio's (1995) definition and d t s in the context of Reamer's

(1992) framework for impairment suggests that at any given moment, a sizable

portion of compassionate pmfessionals may be undettaking significant

professional burdens, in spite of bearing enormous personal distress.

Commenting on the problems of impairment among members of the

dergy, studies by researchers sudi as Hall (1997), Kunst (1995), and von Stroh,

Mines and Anderson (1995) offer little in the way of a single comprehensive

definition, mming instead the potential of s e v d influencing factors, including

alcohol abuse, occupational ~tressois# confüctuig systems functions,

inappropriate semial behaviow, family conflicts, personal moral struggles, and

poverty of spirihial life. The majority of the dergy-impairment literature is

focused within the narrow confines of sexltal misconduct and the abuse of

pastoral power (Fortune, 1989; Steinke, 1989; von Stroh, Mines L Anderson,

1995; Hopkins, 1991; Muse ds Chase# 1993; Alcorn, 1996). Both Forhuie (1989)

and Steinlre (1989) offer pioneering work in the recognition and treatment of

pastoral sexual misconduct, discussing the characteristics common to male derics

Cornpassimate Professionais 27

who engage in extra-marital affairs3, and raising sllnilar issues examining the

factors contriiuting to (and the d t s of) such impairment, including poor

spintual heaith (Hall, 1997), fiawed emotional development, lack of seIf-

awareness? and a sense of narcissistic non-accountability in the offending pastor.

The inauence of work-relateci sttessors upon the perçonal and

professional fundionhg of dergy m e m b is the focus of a &segment of the

developing pastoral impairment iiterahire. Studies by several researdi teams,

including Morris and BLanton (1994a, 1994b, 1995), Hall (1997), K i m a d M m

(1988), Blackbird and Wright (1985), Benda and DiBlasio (1992), Hutduson and

Hutdiison (l979), and others, concentrate upon occupational stressors Speacically

associateci with the pastoral d e .

3 Upon first evafiiation, discussions of pastoral sexual misconduct such as those presented here (Fortune, 1989; Steinke, 1989) wuld appear lo be signifiintly skewed toward, if not exclusively focuseâ on, the benaviours and characteristics of male clergy. This does not suggest that some munen members of the pastorate migttt not also be inclined to abuse the tnst of that office by engaging in sexual or other rnisconâuct; nor doas it imgly that the majority of male cleiics do. lt is, however, a reflection of m i n g social patterns and resulting msearch findings. The informed reac¶er should recagnize that seveml factors rnay be of potmtial influence in this instance, inckrding:

the relative& recerit (late 20th ceritucy) entrance of women into fomally ordained ministry the extremely small permtage of women currently funcüoning in pastoral roles, when

cornparad to the total dethai ôoây the relative scarcity of pubiïiitied material conceming specitlc histoiical incidents, rnembers, or

indiïdual activiües of cwitemglatii cbïstereû, teaching, nursing, and social are rellgious Orders significantly bwer ratios of fernales to males i d e M i amng seraial MenderS in the genefal

population prevaihg sociallcutturai standards regarding acceptaMe ercpressions of indvidual semielity ptevailing expectatbns of, and toletance for, the betravioun of individual6 occupying positions

of go- ard trust the reœnt accentuation of generic proMems of 'male vüMence agaagainst wom' by the vdce of

a ferrjnist generation in media, mearch and po i i i in the iate 20th c8ntury. and an associated focus on issues of m-vlderd gmûer-baJed eKpioitat'i-

The interestet! reader is mferred to the vast (though not necessarily hannonized) litemture reetdity available in a number CH retated arm, such as: pastoral car8 & comseüing; sexW abuse ttieory & therapy; studies of organuatioml psychobgy & dynarnics; gerider situdies; Chutch & social histories; human wuMy; p6ychopathokgy; and professional et--

Cornpassionate Professionais aB

In a 1979 study, Hutdllson and Hutchison bmach a topic traditioMiiy

unheard of among ciergy, namely pastors' eXpenences of divorce, and its

subsequent impact upon th& opportunities for profesional advancement.

Reporting on a limiteci survey of American Presbyterian pastors (n = 331; 157

"ever-divorced", 174 "never-divorced"), Hutchison and Hutchiscm (1979)

identify a derids divorced status as a significant negative factot influencing

overall career development According to this and 0th- research, work-relateci

stressors iikely to increase for pastors as a result of their divorce eXpenence

indude:

higher levels of job insecunty (loss of present position or

future opp~rtunities~ increaseâ iikelihood and h.equency of

geographic relocations)

lower income ievels (direct job lm, dernotion to lower status)

increased Welihood of non-parish pastoral positions, and

(ultima tely ),

mandatory or voluntary departure h m professional

ministry (Hutdiison B Hutdiison, 1979; Morris & Blanton, 1995).

Framing th& investigation in the context of intact clergy familiesr Moms

and Blanton (1994b) discuss several potentially impairing work-related stressors

which appear disproporti~lliitely prominent in the ministerial experience. There

is some overlap between these and the earlier work of Hutchison and Hutchison

(1979); studies conducteci by other research teams support MamS and Blanton

(1994b) by the suggestion of simüar condusioz~s.

Accordhg to Morris and Blanton (1994b), the m a t signifiant work-

related stressors for this population indude: (1) fiequent relocations; (2) finanaal

"undercompensation"; (3) time demands; (4) ambiguous bounàdes; and (5) la&

of social supports. Generallyf clergy f d e s do not remain in the same

geographical area for more than a few consecutive yearsf with moves often

intemipting the family's early development and SOcialization. Negative effects

of this "mobrlity syndromef' (induding loss of support networksf marital

dysfunction, family disiuptionf loss of personal relationships and growth

opportunities) are likely to be expienceci by the ministerîai family (Morris &

Blanton, 1994af1994b; Mickeyf Wilson dr Ashmore, 1991; ûsttanderf Henry &

Hendrixf 1990). In addition, pastorai pfessionals are frequently underpaid,

coriddering both the demands of thei. work, and the educationai levels required

of them. This la& of h a a l resources is a major source of chronic individuai

and family stress (Morris & Blanton, 1994a, 1994b; Mickeyf Wilson k Ashmore,

1991; Benda & DiBlasiof 1992).

When the demanàs of ministry have exhausteci the professionai thne

available to the pastor, pardel resowes of personal and family tirne are

kequently impiriged upon. Confounding the problern is the fact that such

intrusive demands typically anu without waming, driven by emergencies

occwring in the lives of congregants or the communityf rather than as periods of

scheduled working overthe. The frequent eXpenence of sustained los of

private time cian mate negative effects such as the increasecl WLation, loneliness,

and disruptim of the derical family (Morris & Blanton, 1994a, 1994b; Wamer 6t

Carter, 1984; Kieren Q Munro, 1988; Benda & DiBlasioI 1992; Mickeyf Wilson &

Ashmoref 1991). The "fishbowl" effect common to the ministerial family (high

public profile combineci with a loss of protected personal time) often creates a

situation where other famüy boundaries become, or are at least peieeived to be,

permeable and optional ôoth by family meanbers and outsiders. nie

triangulation of congregants into the f d y system, and fragmentation of the

derical family are m u e n t reSuIts of this paaicular stressor (Morris & Blanton,

1994a, 1994b; Benda & DiBbsio, 1992; Ki- & Mumo, lm; Mickey, W b dr

Ashmore, 1991; Ostriander, Henry dr Hendrix, 1990).

Given the recognized rates of mobility and social isolation yiherent in the

pastoral de, dergy families are also W y to experience substantial àisruptions

in established mial networkç, and to encounter fewer oppottunities to constmct

extensive new ones. Frequent removals £rom extended family and community,

and the la& of readily accessible (long-term, stable) extemal relationships

impose additiod stressors upon the primary relationships of the ministerial

family. Finally, effective denominationally-based family support semices are

rare; those that do exist are kquently pmven inadequate for pastoal famüies in

need of them (Morris dr Blanton, 1994a, 1994b, 1995; Kieren B Munro, 1988;

Wamer & Carter, 19û4; Blackb'i & Wright, 1985; Benda & DiBiasio, 1992).

Imvaiment Risks Amss the Professions

Noted at the beginning of the present chapter, and demonstrateci

throughout this review is the recognition that no single standard currently exists

desning the term "professional impairment" (Sherman, 19%; Sheffield, 1998).

Rather, it appeivs to acquite differing emphases depending on the dixpline, the

era shaping the profession's development, and the conditions under which the

question of impairment is being considemd. One theme consistently addressed,

however, is the expectation that the compessionate professicmal must be able to

demonstrate competency in the attainment and maintenance of certain levels of

practice (Fortune, 1989; Lamb et. al, 19û7; Reamer? 1992; Sherman 8 Thelen,

1998). These aiteria are genedy held to include the ongoing pursuît of

professional training supervision, and personal development, in addition to

formally prescr i i educational programmes. If the hdividual practitioner

tolerates a defiat in, or an e d o n of these expectations of excellencef the risk is

high for encountering signihcant impairment in his or her professional

functioning .

NRnowin.~ the Focus of the Imvaimtent Literature

In the history of most disaplines, the bulk of the literature examining

impairment themes has been generated relatively recentiy? almost aU of it within

the past 25 years. In the instance of coumehg, this same thne period

approximates the emergence of the discliphe as a recognized profession, during

which the foundations of counsehg theory and skills have been estabiished as

distinct h m th& mots in academic psychology (Vance Peavy, 19%; Hazler dr

Kottler, 19%; Herlihy? 19%). Given this developmental stage, both scholarly and

anecdotal treatments of impaired coullseuor issues are SU relativeiy spafsef anà

the profession as a whole is only now turning its scmtiny upon this Achille# heel

(Olsheski & Leech, 19%; Hazler & Kottler, 19%; Sheffield, 1998). Several authors

speQndly comment on the relative scarcity of literatuile addressing the issues of

impairment in the couriselling pfession, including Olsheski and Leech (19%),

Vamos (1993)f Counselsnan a . Alonso (1993), Witmer and Young (19%), and

Sheffield (1998). A similar deficiency is noted in regard to clergy impairment

issues, as reporteci by M d and Bhton (1994b). The majority of the literature

which dœs &t in either field tends to concentrate on three general areas:

1) detection and recognition of various addictions-,

competency-, and ethically-based impaiimmts (Fortune,

1989; Epstein & Simon, 1990; Hopkins, 1991; Owen, 1993;

Menninger, 19%; Emerson & Markos, 1996; McLeod, 1992;

Sherman & Thelen, 1998);

2) assorteci mdeis for the intervention and treatment of

substance- or stress-induced impainnents (Hopkins, 1991;

Okheski k Leech, 19%; Witmer 8 Young, 1996); and

3) questions of ethics and action assoàated with the confront-

ation of colleagues who may be experienchg impairment of

any origin (Gd, Thoreson & Shaughnessy, 1999; Neukrug,

Healy dr Herühy, 1992; Hazier 6r Kottler, 19%; HeriihyI 1996;

Hohanf 1995; Gibson 6r Pope, 1993; von St& Mines &

Anderson, 1995).

A refreshingly positive approach to issues of professional impairnient is

one reflected by Witmer and Young (19%) in their emphasis on the necessity of

"preventative welhess,'' both in the progammes/methods of counsejlot

training, and in later-career clinical practices. According to this research team

(Witmer L Young, 19%), the bkehhood of a compassionate pfessional

succumbing to irnpairing conditions may be signiacantly reduced by the

dtivatim of proactive measures and activities in severd areas of life (e.g,

exerQPng creative problem-solving skillsf developing a saw of spinhiaüty,

maintainhg good physid health). Where the greater part of the professional

impairment literature is occupied with identïfying antecedents to an individual's

deterioration, or with "picking up the pieces" after the fact, Witmer and Young's

(1996) attention to the antecedents of professional wellness offers a balanced

peftpective to the disCuSmon. This position is consistent with cum?nt

developments in stress and coping theofy (Wong, 1993); a criticai bridge

between these two areas of investigation win be exploreci in further depth

elsewhere in the present work.

Definina Non-Volitional Imvuimient

Within the demonstrably limited body of evidence and conceptuaiization

conceming professional impairmertts, an even d e r duster of work examines

the question of "non-volitionai" stressors and impairment arnong therapists.

For the purposg of the present discussion, a "non-volitional stressor" is bneny

defined as any condition leading to pemonai distress (such as a sudden illness,

bereavement or other catastrophic chunstance) k i t may randomly,

unavoidably, si@can~y anci adversely affect the Me of one who works within

the compassionate professions. The term "non-volitionai impairment" is, by

extension, reflective of any personai distress directly resuiting frorn a non-

volitionai stressor. Under this definition, a distinction is made between the states

of professionai bumout and non-volitional impaiment. Where h o u t

develops as a function of the work and workîng conditions of the compassionate

professional, nomvolitional impainnent originates h m signifiant, random

shpssor events or conditions in the individual's personal Me, exaspeated by the

demands and experiences of the the compassionate profession.

Non-Volitional Itntlainnmt and the Psvchonncrlvfic Permeciive

The in£iuential power of the theirapist's Iife events upon the therapeutic

relatiOI\Ship is a hctor that has received scattered and inconsistent recognition in

the psychoanalytic tradition. According to one ment evaluation, Freud's

insistene that analysts paiodicaily assume the analysand role was based, in part,

on the belief that "therapists' personal problems may, if unidentifieci,

unexamined, and unaddtessed, interfere with the ability to conduct effective

Uie~aw (Pope 6r Tabachnick, 1994, p. 247). At the same the, in spite of his

previous assertion that "completely sound phytid health" (Freud, 1900, cited in

Schwartz dr Silver, 1990) was necessary for the execution of the andytic arts, the

impact u p n his ciinid work by Freud's own lengthly and debilitating struggle

with cancer is virtuaiiy ignored in his extensive writings, and those of his

biographers (Schwartz, 1990). In conhast, Cetson (19%) revisits Fromm-

Reidiman's advice to psychiahists (1950, ated in Gerson, 19%), urging them to

be cognizant of the influence thev own "intercurrent events" (e-g., marriage,

divorce, death, childbirth) have upon their therapeutic effectiveness. In a similar

vein, although writing from substantially different pezspectives, Gmebaurn

(1993), a Fteudian psychoanalyst, and Hicks (1993), a military diaplain, affirm

one another's foundational observation; namely that, without the capaaty to be

vulnerable in Ue, authentic experiences of empathy for the pain and suffering of

ano ther person are not possiile.

For the most part, however, the pfession~s awafeness of the individual

therapist's "personhd (Mitchell, 19%) in relation to the impact of Me events

upon professional hinctions has been ümited, transmitted through various

anecdotal accounts (Gnmebaum, 1993; Nadelson, 1993), and in the context of

discussions fe8arding transference/~~~~itertransferenœ issues relative to the

patient's progress (Gerson, 19%; Schwartz 6t Silver, 1990). In a statement whidi

could easily apply to professional colleagues m medicine, c o m d h g , or the

pastoate, one editorial team Wfites regarding the psychoanalysts:

We are intrigueci Uüit it has taken the profession a cenhuy

to adoiowledge directly the speafic effects of the morbidity

and rnorfality of its practitioners. ...As we becorne seasoned

pfessionals, we learn through the Me experiences of others

and o d v e s , to cope with out own ralamities, or so it is

assumeci. But if we were to hm@ guidance to our personal

fibruries, we mi@ t&f incretzsingly abne, seing hoPv cumpletely

the issue has been ignored, (Schwartz dr Silver, 1990, p. 3;

emphasis added).

While it is beyond the scope of the present discussion to pursue a

thorough investigation of even UUs limited dimension of the psychoanalytic

tradition, a bnef tally of some recent discussions regarding non-volitional

stressors and impairments is appropriate at this juncture. An eady exampie of

this material is Weinberg's (1988) discussion of the analysYs experience with an

intrusive illness in the course of therapeutic work with clients. LasYs (1990a)

contribution, "Catastrophic illness in the analyst and the analysYs ernotional

reactions to it," is another early effort to distinguish traditional issues of

therapeutic countertransference as secondary to the more hdamental

experiences of being a very ill person who must still function as the emotional

support of clients. The timing of Lasky's (1990a) article coinad& with the

emergence of a concentrated duster of related literatwle, appearing both in

jouniais (Simon, 1990; Counselman & Alonso, 1993; Varnos, 1993; Philip, 1993;

DeWald, 1994), and edited coUections such as ' T h e s in the analvst Im~licatiions

for the treatment relationshb (Schwartz & Silver, l990), "Bevond transference:

When the thera~ist's teal life intrudes" (Gold Q Nemiah, 1993), and "The

therapist as a a w r s o n : Life crises, iife choices, Me experiences, - and theV effects on

treatmenr (Gerson, 19%). These authors explore a spectnun of personally

catastrophic, and potentially impaving life events, induding the deaths of a chüd

(Chasen, 19%; Lazar, 1990), a parent (Warshaw, l%), and a spouse (Vamos,

1993; Morrison, 19%); life with a "terminai" or debilitating disease (Philïp, 1993;

Silver, 1990; DeWald, 1994; Momkm, 1990); the devastation of divorce

(Schlachet, 19%; Johansen, 1993); and othe~ traumatic acperiences (Stevens, 1996;

Morrison, 1996).

Predictably, the majority of this material is devoted to traditional Fmdian

analysis of such issues as tramference and countertransference, fantasy

constructions and hinctions (Woimart, 1990; Nemiah, 1993), " d y s t

enactments," "selfobject needs," and "seEstates" (Morrison, 19%). A few

authors, howwer, do venture into discussions of more concrete pfessionai

issues relateà to the intrusion of non-volitional stressors into the Me of the

therapist. %me of the topics touched upon in this subsection of the

psychoanalytic literature indude: practicing while eXpenenchg diminished

cognitive, physical and/or emotional capaaties; degrees of self-osure;

suspension of practice and related arrangements for notification or coverage;

and signiticant financial conœms due to interrupted practice (Counselman Q

Alonso, 1993; Philip, 1993; Vamos, 1993; Monbon, 19%; Civin dr Lombardi, 19%;

Lady, 199ûb; DeWald, 1994).

Ernvi&al Investikations of Non-Volitional Rofessional Irnvahent

Whüe much of the material deaüng with non-volitional impairments has

been generated by authors holding orientations of various psychoanalpic

schools, empincal evaluations are beginnuig to make th& mark upon the

fiterahire (Sherman & Thelen, 1998; Sowa, May & Niles, 1994; Pope dr

Tabachnick, 1994; Coster Q Schwebel, 1997; Mahoney, 1997; Schwebel & Coster,

199s).

Conducting a mdest investigation into the stressors inherent in the

counseiiing profession, Sowa, May and Niles (1994) report on a sample of

counsellors (n = 125) practicing in a variety of settings in the state of mrguiia.

The research questions framing this investigation (Sowa et. al., 1994) provide

important background to the present discussion conceming non-volitionai

impairments among clergy and counsellors:

do counsellors report markedly different leveis of work-

relateci stress, symptoms of personal stress, and coping

resources than reporteci nonns among other ptofessionals?

do valid measures of "personal strain" and coping resources

d e c t differences between counsellors reporthg high leveîs of

work-related stress, and those repotting low levels?

are counsellors' experiences with levels of work-related

stress, personal &stress and coping resources affected by

professional training?

Employing the Occupational Stress hventory (Osipow B Spokane, 1987,

cited in Sowa et. al., 1994), Sowa, May and Nies (1994) report mixeci hdmgs

h m ttreir limited samp1e. Fitstly, the researchers note that subjects did not

perceive themselves to be under a greater burden of stress than other

professionalS. Considefing th& second question, higher work-relateci stress

levels are associateci with lower levels of coping strategies in mas of self-care,

recreation and social support. However, no negaüve correlation is reporteci

between levels of stress and coping strategies of rational/ cognitive problem

solving. According to Sowa, May and Niles (1994, p. 7) " teaching rationai

problem-solving s W by ikelfdocs not trmslate into wunselm havïng th necessznj

reperfoire of coping skills to daal with stressfil mvironments" (emphasis added). This

observation is consistent with recent caUs within the profession for mater

attention to the development of proactive, multiple coping strategies (Wong,

1993).

Regardhg their two remaining questions, surrounding the effects of

professional preparations upon counsellors' circurnstances~ and perceptions of

work stressors, personal strain, and coping resources, Sowa et. al. (1994) report

that respondents with specinc training in stress management presented a greater

repertoire of self-care and recreational coping resources than did th& coileagues

who lackeù such proactive training. Of interest in this portion of the analysis is a

finding that (in the context of that study, at least) the sarne stress management

training did not appear to advantageously influence the development of the

coundlors' resources via &al supports (Sowa? May & Niles? 1994). While Sowa

and her assodates (1994) make no clalln to presenting "cutting edge" conclusions

through theV study, theV research nevertheles contributes positively to the

m e n t state of counsellor development literature? and solidly positions the

authors with others (Frame 6r Stevens-Smith, 1995; Witmer B Young, 19%;

Coster dr Schwebel, 1997; Schwebel6L Coster, 1998; Sherman & Thelen, 1998;

Baml, 1999; Sheffield, 1999) who voie a particuiar ConceZn regarding the

adequaaes and appropriateness of professional counselior training-

Another exploration of the link between issues of p e d distress a .

conditions of professional impairment, conducted against a background of

*'Mestyle, stress and coping theory,'' is off& in a ment enpirical investigation

by Sherman and Thelen (1998). Shidying the self-reported expexiences of a

sample of ciinicians (n = 513) drawn from the roster of the American

Psycholo Jcal Association (MA), the researchers (Shman 6r Thelen, 199û)

present an analysis of the quality and prevalence of distresshg life events

(ranghg lrom bereavement, to finanaal pressutes, to phase-of-life

developments), and subsequent expenences of professional impairment. As has

been noted arnong other authors and researchers, Sherman and Thelen (1998)

acknowledge the troublesome ladc of consensus within the profession regardhg

definitions of impairment. Differentiating "impairment" fKnn "distress" at the

outset of their study, they offer the foilowing helpful Cianfications:

[impairment is] the interference in ability to practice

therapy, which may be sparked by a variety of factors

and results in a dedine in therapeutic effectiveness,

(Sherman 6r Thelen, 1998, p. 79).

In conttast, "distress" is explaineci as:

a subjective eXpenence of discontent that may arise from

various fadom and that may be manifesteci in 'anxious or

depressed moods, somatic complaints, lowered self-esteem,

and feelings of confurnon and helplessness about their

problems', (Sherman 6r Thelen, lm, p. 79).

The primary assessrnent instrument employed in this m e y was

consûucted by the research team, based on pilot investigations using Sarason's

Life Experiences Scale (SLES; Sarason, Johnson Q Seigel, 1978, ated in Sherman B

Thelen, IM), adjusted and augmented spedically for Sherman and Thelen's

(1!39û) study. nie final fonn of the instrument addresses occupational factors

and non-volitional sttessors (e.g, bereavement, personal ïnjuq). An additional

instrument, the Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen &

Griflen, 1985, ated in Sherman & Thelen, 1998) provides an additional source of

data, tapping both persona1 and professional life domains.

Consistent with Figley (1995), Lamb et. al. (1987)' Pope and TabaIhnick

(lm), Gerson (19%), Sheffield (lm), Sherman (19%), Herlüiy (19%)'

Menninger (19%), Philip (1993), and Lasky (1990a), research partners Sherman

and Thelen (1998) find the existence of a positive correlation between distressing

conditions, both personal and occupationai, and the impairment of profesional

hctions in the respondent group. According to these researchers (Sherman L

Thelen, 1998), stressors here identifid as "non-~01iti0na1" in nature (e.g. major

iUness, relatimhip problems) create the greatest level of distress and

impairment in responding professionals.

Conceming gender differences, the researchers report that no signifiant

distinctions appear between men and women when considering the suznmed

totals of responses related to ''Me occurzences," 'We distress," or 'We

impairments" (Sherman 6t Thelen, 1998). They do, however, note some gender-

baseddisslmilan . . 'ties in the m e f s wosk-related factors. Women respondents

"reported experienQng a signincantly p a t e r number of stressfuf events than

men,. .. [and alsol reported signiticanüy more summed work distress" Uian did

the men (Sherman & Thelen, 1998, p. 81). A further gender spüt appears where

Sherman and Thelen (1998) report their findings conceming preventative

measures of self-cm: women respondents are noted as engaging in a

signiscantly higher number of proactive and prevention activities (e.g., regular

exercize, partiapatim in churdi/spintua.i activities, use of personal thetapy) than

are the men in this group (Sherman dr Thelen, 1998).

The kt of eighteen preventative strategies generated by this sample of

therapists appears balanceci between private and professicmai emphases. While

Sherman and Thelen's (1998) table presents these "prevention behavim"

according to the frquenaes and percentages by whkh they appear in the whole

group, categories created by focusing on either the occupational or personal

areas would also be appropriate. The proactive measures ciosely related to

professional adivities indude: periodic condtation and supenrision, scheduied

breaks and limiteci bookings of back-bback sessions, use of stress andior t h e

management skills, maintenance of a b c e d caseload at a realistic level, use of

professional network supports, and refusal to accept certain types of dients (the

recognition of limits of competency andior persona1 boundaries) (Sherman bt

Thelen, 19%). The personally oriented seif-care activities named in Sherman and

Thelen's (1998) study indude: participation in activities not relatecl to profession

or worksite, periodic holidays, reguiar exercize, active networks of social

support, engagement in church/spiritual life activities, personal therapy or

support groups, and other (undefined) efforts.

Although the issue of non-volitional stress and consequent impairment

among compassionate professionals is not the primary focus of Sherman and

Thelen's (1998) investigation, the problem does becorne evident in the Mer contact of the study. Of the significant and distressing W e events" detailed in

th& research (Sherman k Thelen, 1998), severai reûect a dimension of personal

catastrophe (e-g., bereavement, major illnessO nahua1 disaster) which is inherent

in the present definition of non-volitional stressors, but which is not a necessary

component of simple phase-of-life developments, or other sources of stress.

Preiiminary findings such as these reported by Sherman and Thelen (1998)

convey the necessîty of developing and clanfying an adequate concephial

framework addressing non-voütional stressors and subsequent impairment in

the experience of counsellors and dergy.

Issues of distressO impairment and "well-functioning" among professional

psychologists have received further investigation in cornpanion stuclies recently

conductecl by Coster and Schwebel(1997; Schwebel k Coster, 1998). Adopting a

position çimilar to Witmer and Young's (19%) emphasis on therapists' healthy

adaptations to occupational and personal stressors, Coster and Schwebel(1997)

be@n with the simple (perhaps obvious) asmmption that the normal state of

being for the professional is one of weil-functioning not dysfunction.4 Fmm this

position, they define impairment as "a dedine in quality of an individual's

professional hinctionllig that d t s in consistentiy subsbndard performance,"

4 There is parenthetical value in examining the authors' choice of the tenn WeH-functioning". The secondary purpose is simple deference to gramnatical p r o s c r i p ~ regardhg the doMe negatïve Wkh would be cmated by the construction 'unimpairment". More importantly, though, Coster and Schwebei (1997) that prdessionally inaâequate fucictianing may resuît from sources other than impairnient nameîy, i n c o ~ e n c e or pathobgical conbhhns. Mhile it b beyond the s- of the presecit discussion ta pursue an adeqmte expbratüm of the constituent causes and effets invohmd in these prdessbnai and personal hirûrances, both incornpetence and specrt~ psychopatnologies (e-g., ~ d C s o r d e r s , m o o d d i s o r d e c s , o r d e m e c i t i a s d o r g a n k o r i g i m ) ~ ~ q ~ a s ~ ~ impairment distinct ?rom %adibnal" problems of addictions (Coster & Schwebel, 1997; Pope & Tabacnriick, 1994; Pqm & Vasqwz, 1991 ; Rame & Steve~m-Smiai, 1995; Sherman, 1996; Swie ld , 1998; BisseJi, t 963, CM in bdh Sherman, 1996 and Shetfield, 1998; and On, 1997).

(Coster & Schwebel, 1997, p. 5). In the same context, "weii-functioning' is

described as an "enduring quality in one's professional functioning over time mid

in theface ofprofessional ami p m o ~ l stressms," (Coster & Schwebel, 1997, p. 5;

emphasis added).

The k t of the two articles (Coster (Ir Schwebel, 1997) presents a double

study. The initial investigation, focusuig on interviews with wd-functioning

psychologists who had been nominateci by professional pers, yields ten themes

which the investigators (Coster (k Schwebel, 1997) identify as "important

contriibuors" to the professional's well-Eunctioning. Ranked according to the

subjective impressions drawn by one of the authors during the interview process

(Coster Q Schwebel, 1997), these themes incorporate the foilowing proactive

measures:

1. peer support

3. supervision

5. graduate schooI experience

7. continuhg education

9. c a b / implications of impairment

2. stable petsonal relationships

4. a balanceci life

6. personal psychotherapy

8. family of origin

10. coping mechanisms

The second study p~esented in this investigation examines resuits hom a

sampIe of 339 New Jersey psychologists respcmding to a survey package

including three instruments: a general demographic questionnaire, the

Impairment Questionnaire o, and the Well-Functioning Questionnaire

(WFQ) (Coster & Schwebel, 1997). While the h p Q had been ernployed in

previous and related research, the WFQ was mnstructed SPeQfically for this

section of the shidy, drawn from results of the earlier in* discussed above

(Coster 6 Schwebel, 1997). Coster and Sdiwebel(1997) report on several

statisticai findings generated by this second study, including gender differences,

the signiscance ratine on several factors of wd-hctioning, and the analyses of

variance ewminllig states of impairment versus well-functioning. In general,

respondents endorsed strategies of seIf-care with an emphasis on personal

relationships and supports, in preference to academic training as the most

valuable sources of weU-functioning (Coster Q Schwebel, 1997). Overall? the

research generated in Coster and Schwebel's (1997) investigation supports the

work of other theorists and researchers (Wong, 1993; Sherman, 19%; Witmer dr

Young, 1996; Sherman & Thelen, 1998; Frame Ek Stevens-Smith, 1995; Pope L

Tabachnick, 1994) who advocate the profession's practice of preventative and

proactive efforts in relation to weii-hinctioning and the avoidance of

impairment.

Extending the previously c k u s s d research is Sdiwebel and Costefs

(1998) d a t e c i investigation, which considers issues of psychologis ts' well-

functioning as perceiveci by the professionals responsîîle for graduate

programmes and related training protocols. According to the authors (Schwebel

6r Coster,1998) a reasonable expectation exists that, in generai, progamme

heads (occupied as they are with matters of acadernic preparedness and

credentialling) may hold differing opinions about factors involveci in impairment

and well-functioning than do the career practitioners sampled in the previous

shidy (Coster & Schwebel, 1997). This is amsistent with positions presented in

the work of Wihner and Young (19%), Fame and Stevens-Smith (1995), and

Sowa, May and Niles (1994). Given this ohmation, it appeam evident that

specifdy ccmsuiting with programme heads as a distinct subpapulation of the

profession offers a balance not previously achieved in examinations of well-

hctioning versus impairment Issues.

Schwebel and Coster (1998) report on the r d t s generated by a survey of

107 respondents, heads of APA certifieci clinid, counseîling and school

psychology programmes. The unnameci survey instrument, speaficaily

designeci for the reseatchefs pmject, is an extension of the WFQ used in the

tearn's prior study of praditioners (Schwebel h Coster, 1998). S d a r to the

responses of the professionai psychologîsts in the k t investigation, the

programme heads in Schwebel and Costefs (1998) mixequent study endorsed

personal and existentid items (eg., self-awareness, personai values, f d y

relatiomhips) as criticai elements in maintainhg well-functioning s ta tes.

However, exhibithg a signiscant ciifference h m the practitioners surveyed in

the earlier shidy, the programme heads allocated Mirtually equal weights of

importance to those items tapping the "didactic, supemsOry, and experiential

aspects of the graduate school experience," (Çdiwebeldz Coster, 1998, p. 285).

Although distinctions are presented between the statbtical hdings of

these cornpanion investigations - findings not presented in detail here - the

overall implications of the second shidy (Schwebel & Coster, 1998) are consistent

in essence with the team's earlier work (Coster 6r Schwebel, 1997), in that both

studies support the necessity of exercizhg proactive measutes to enhance

professional well-Mg and functions, and to avert potentially impairing

conditions. That both groups, practitioners and academics, appear to emphasize

differing areas within that recognition is of secondq importance. In a lengthly

discussion of the implications and potential applications of th& tesearch me&,

Schwebel and Coster (1998) again focus on the necessary relationship betweai

training goals, career eXpenences, and the proactive coping skills of

compasionate professionals, stating:

what is paramount is not that every professional 't' is

aossed and 'i' is dotted in the knowleàge domain but t h t

the graduates emnge os well-jhnctioning individuals who m

as expert in self-cure as in caringfir the needs of 0 t h (p. 289;

emphasis added).

A further example of the inaeasing empincal evidence relateci to non-

volitional impairments is a recent, brief survey by Mahoney (1997) focushg on

patterns of the personal problems, seIf-care practices, and use of personal

U i e r a ~ arnong professional psychotherapists. Reporthg on a relatively srnail

(n = 55) nonrandom sample of practitioners, Mahoney (1997) notes that dusters

of "emotional exhaustion and fatigue" were the most kquently reporteci

personal problems, although by fewer than half of the respondents. Less

frecpent eruiorsements induded relational problems, emotional isolation,

professional h o u t symptoms (e.g, disillusionment, d o a d concems),

anxiety, depression, somatic concems, and substance abuses; findings that are

g e n d y consistent within the field (Pope &r Tabachnick, 1994; Sherman L

Thelen, 1998).

Mahoney's (1997) survey reflects a diverse ange of self- strategies

within this group of compassio~te professiods, including measures that may

be variously r e f d to as physicai (e-g, exercize, pfeventative hed-

practices), mental (e.g, "pleasure'' reading, hobbies, vacations, professional

supervision, culhval events), and spintual/e>ristentid (e.g, payer or meditation,

worship, volunteer comrnihnents, persmal therapy, journalling). According to

this study (Mahoney, lm), while no discemicble gender dikences appeared in

the pfessionals' perceptions qarding the value of personal therapy, women

therapists were signincantly more likely than men to engage in personal th-

as a method of self-support. A similar split is noted dong professional lines, in

that therapists holding nonaoctoal aedentials were more iikely to report

participahg in personal therapy than were theh doctoral-level colleagues

(Mahoney, 1997).

Mahoney's (1997) 6ndings regarding th& sample's spiritually~riented

self-care activities are noteworthy. While slightly iess than a third of the gtoup

were currently engageci in some form of psychotherapy, fuliy half of the

therapists responding daimed a personal practice of either prayer or meditation

(Mahoney, 1997). Similarly, wwhüe about forty percent of the respondaits

adcnowledged the value of chanty volunteer activities as part of th& self-cive, a

strong third of the p u p also endorsed participation in f o d worship activities

(eg, church Sennces) as integrai to rating weU for themselves. In the context of

proactive coping efforts (Wong, 1993), Woney's (1997) report conceming the

value these therapists place on attention to dimensions of personal spirituality is

espeaally saüent, given the present discussion of non-volitional stressors,

impairment, and d e n c e among pastoral and counsehg professionab.

A related study, one considerably more extensive than Mahoney's (lm,

is found in a sunrey of pmfess id psycholagists caiducted by Pope and

Tabachnick (1994). Ln this broad investigation, focused on pfessionals who

eXpenence the d e of patient thraugh the exploration of personal

psych~therapy~ the researchers (Pope dt Tabachnick, 1994) daim a kee-iold

intention:

1) to coUect arploratory data h m a sample of psychobgists

regarding beliefs about therapy, precipitating problems

leading to th& use of personai therapy, and their therapeutic

@ences;

2) to seek confirmation of fùidings deriveci h m ptevious

related studies in this area; and

3) to gather data for the consideration of a multipiiaty of

secondary questions (more than 9), including "what is the

major problern, distress, dyshction or issue addressed

in therapy" by the professional-as-patient?

A total of 476 practitioners of clinid psychology, comselhg psychology

and psychotherapy participated in th& research (Pope & Tabachnick, 1994).

Consistent with Mahoney (1997), and Sh- and Thelen (lm), Pope and

Tabachnick (1994) report that a sigdicantly greater proportion of women than

men in the sampIe pufsued thetapy in response to peftanal distress. They

further note that younger professionak (those unàer 40 years of age) were more

lïkeiy to engage in personal therapy? either current or past, than were their

colleagws of a pater age (Pope & Tabachnick, 1994).

Pope and Tabachnick's (1994) sample generates a considerable List of the

problems, distresses, dyshctions and issues which may compel professionals to

assume the patient role through th& own personal therapy. Of the 34 specifïc

categories (excluding "miscellaneous") tabled in this study (Pope & Tabachnidc,

1994, Table 3, p. 249), a large portion are consistent with issues contained in the

present denniaon of non-volitional stressors and impairments, includuig issues

reiated to abandonment and family-ofaigin, sexual assault and/ or abuse,

childhood abuse, grief, trauma and/ or pt-traumatic stress, medid conditions,

and personality disorders. Pope and TabachnicWs (1994) research also reveals a

bnef but critical list of distressuig circumstances whidi the anonymousiy

responding professionals acknowleàge they have kept (or would keep) secret

£rom others, refusing to disclose even in a therapeutic relationship. These

ciraunstances indude sexual issues, feelings regarding the therapist, personai

histories of abuse, active substance abuse, eating disorders, third party identities,

and unnamecl niiscellaneous problems. Additionally, accmding to Pope and

Tabachnick (1994), the occurrence of serious depression as a source of distress

was remarkably high in UUs goup of practitioners. Sity-one percent of the

respondents acknowledged having lived thugh at least one episode of d h i d y

defined depression, twenty-nine percent reporteci having experienced suiadal

feelings, and alrnost four percent Wosed surviving at least one &de attempt

('Pope & Tabachick, 1994).

The major focus of Pope and Tabachnick's (1994) investigation is an

analysis of the therapeutic experiences and beliefs of the therapist-as-patient.

However, their initial exploration conamhg the types of stressors and

impairment that may move cliniaans to seek personal therapy (Pope k

Tabachnick, 1994) is particulailly important, given the contat of the present

disassicm of non-volitiod ïmpainnents and compassionate pfessianals.

While Pope and Tabachriick (1994) caution readm Uiat theh study is subject to

several flaws inh-t in survey-based research (e.g., self-selecting samples,

responses infiuend by social conformity, inaccutacies of memq), and that

th& findings la& the confirmation of replication, they nevertheles conhcbute

information of substantial value concemirtg the "mal-Me" dishpsses of

professional psychologists; information that is consistent with the findings of

other recent researchers (Mahoney, 1997; Sheman 6r Thelen, 1998).

Cliapter lhree

EXlSllNG MODELS

Among the few investigations applicable to issues of non-volitional

impairment among compassionate professionais there is a notable, but limited

body of work rooted in the fi& of psychotraumatology, and mounding an

emerging phenornenon labelleci "secondary traumatic stress disorder" (STSD)

(Figley, 1995; Sherman, 19%). According to the most ment editim of the

Diagnostic and Statistid Manual of Mental Disorders (DSM-IV, 1994), there

exists a condition known as " posttraumatic stress disorder" (PISD), which is

diagnosed in the presence of:

the development of characteristic symptoms following

exposure to an extremely traumatic stressor involving

direct pemmaI expen'ence of an event that involves actual

or tfireatened death or serious injury, or other threat to

one's physical integrity; or witnessing an event that involves

death, injury, or a Uwat to the physical integrity of another

person; or leamhg about unexpected or violent h t h . &ous hm,

or thrmt of doath or injury expe~enced by a fanify member or 0 t h

close assuahte, @sM-IV, 1994, p. 424; emphasis added).

The referenced "characteristic symptorns" of RSD include a broad range of

affective? cognitive and physiologicai disturbances telated to amusal states, fear

responses, and subsequent psychol0ga.i disorganization @SM-IV, 1994). Much

the same description is applied to the positeci syndrome of secondary traumatic

stress disorder (STSD); however it has yet to aqyire the authoritative

endorsement of the DÇM-N or its supplements (Figley, 1995).

In a ment exaatination of mental health problems ptevdent among

psychotherapists, Sherman (19% p. 306 - 307) points to the risk of vicarious

traumatization, descriig "the stress reactions [ofj therapists who hem horrific

stones of intense suffering by s u ~ v o r s of some trauma." Figley (1995) and his

colleagues Wnte at length concffning the psychologid hazards inherent in the

function of trained helpers who are consistently exposed to the immediate

traumas and suwivorship of others. According to these researchers (Figley,

1995), SrSD may be especially common in a range of pmfessionals and

paraprofessionals, including crisis and emergency responders (police,

fire/rescue, parameâic and dispatch personnel), emergency rmm doctors and

nurses, mentai health therapists, and degy. Wriüng h m a unique perqwdive

connecting pastoral, therapeutic and military des , Hicks (1993) makes simüar

observations regarding the impact of secondary trauma upon compassionate

helpers, whether they are pmfessionals, disaster scene volunteers, or

happenstance witnesses.

A select group of other theorists and tesearchers (Jung, 1966; Farber, 1985;

Guy, 1987; Freudenberger, 19ûû; and Briere, 1992, a l l ated in Sherman, 19%;

McCann Q Peariman, 1989; Miller, Stiff 6r Ellis, 1988; Remer k Elliot, 19W; and

Harbough dr My=, 1985, al l cited in Figiey, 1995) similarly suggest the existence

of a corollary between extended or complicated trauma-work, and therapist

distress. Additiomlly, numerous labels appearing in the 1iterah.m of the last

decade point toward the reality of ûinical awateness concerning secondary

traumatic stress affecOng both family and pmfessionals, including the terms

"secondary victimization," "CO-vicümization," "secondary stuvivor," "emotional

contagion," "raperelated family crisis," "proximity effects," "gene~ationai effects

of trauma," "family toxification," "secondary catastrophic stress reactions," and

"sadour syndrome0' (Figiey, 1995). Clearly, these authors and labels represent

an accumdating body of evidence calling for the recognition and indexing of

ÇTSD as a valid clhicai syndrome among mental health and emergency workers;

a call for the acceptance of the disotder on par with PTSD (Figley, 1995), itseIf

ody recently admitted to the psychiatrie Iexicon (DSM-IIï, 19ûû).

A Mode1 o f Comtlussion Stress und Comvassion Fatirne

Considerd in Uùs hqer context, substantial justification &ts for the

examination of more speafic issues of non-volitional impairment arnong pastors

and counsellors. Partiakly appropriate to Ulis exploration is a provocative

mode1 of the transmission of STSD, presenting distinct but overlapping concepts

of "compasion stress" and "compassion fatigue" (Figiey, 1995; Figures 1 & 2).

Developed from extensive study of the experiences of both survivors of

catastrophic events (whether of the naturd world, or resuiting fnnn human

actions or technologies), and of the workers - often therapists - whose

speaalties engage them in intense exposure to these Sunnvors, Figley (1995, p. 9)

offers a model whkh graphicaily explains "the cost of caring for 0th- in

emotional pain"

The STSD Transmission Model (Fidey, 1995) is framed in two phases. The

first, "compassion stress," d e s c n i the concentrateci strain assoSated with an

individual's intimate exposure to another's Stlfferings. According to Figley (1995,

p. l), "the most effective therapists are most vulnerable to this mirroring or

contagion effect. Those who have enormous capacity for feeling and expressing

empathy tend to be more at risk of compassion stress." Preapitating and

sustaining this sensitive burden is a combination of factors (Figley, 1995) which

seem to draractetize the function of compassionate pfessionals: empathic

ability, emotional contagion, empathic cmcem, empathic response, aadevement,

and disengagement (Figure 1). Although Figley (1995) does not dkws the

minute definitions of these factors, it is esenoal that the basics are dearly

understood in th& individual contexts, and within that of the iarger

ÇIS/ compassion fatigue model.

The first dement, empathic ability, identifies a person's capacity to be

aware of the experience of pain in another king. Possession of this perceptive

characteristic would seem to be requisite for persans who hction in the

compassionate professions. This comrn~n~sense eXpeaation of empathic aWty

seems obvious, receiving endorsement by most counselling theorists, induding

Jennings and Skovholt (1999) in th& recent analysis of the chatacteristics

attri'buted to master therapists.

Close1y aligned with empathic ability is the second factor, that of

emotional contagion. According to Figley (1995), this is an emotional sense of

"being swept up" by close identification with the victim's feelings - just as if

they were one's own - by vittue of witnessing the person's experience of

trauma-induced stres. In Figiey's (1995, p. 252) tennuiology, emotional

conta* is "the uoy essence of thefiehg of c o m p ~ s s i i o n ~ umtW (emphasis

added).

Ernpathic concem is the third element contnhting to the composition of

compassion stress (Figley., 1995). Figley's description of this companent., also

closely aligned with empathic ability, is i s b r i e f : it addresses the helpefs motivation

to relieve the suffering observeci. It is possible, since this factor appears to

tepliesent traditional ideals of altmim, that the essence of empathic concem is

better caphued by more lyric descriptions of "a semant heart," "the quality of

mercy [that] is not strained," or "the greater love."

Figley's (1995) fourth elernent, empathic response, is the mannet in which

the previously identified abilities (to feei, to care and to fuid the motivation to

relieve another person's pain) are ttanslated into action. It is the point at which

these emotiond energies crystallize into concrete efforts âirected at supportrng

the victim/sunrivor in the t rama experience. Without some form of response,

whether material, organizatiod, therapeutic, spiritual or physid (Figley, 1995),

empathy - or more c o d y , sympathy - is of littie value in itsei€, anand dws not

extend beyond the potential helper.

A fifth factor contniuting to compassion stress lies in the professional's

own perceptions of success or failure when meeting the thetapeutic challenges of

anothefs traumatic eXpenence (Figiey, 1995). Compassion stress is l e s M y to

develop under conditions in which the caregiver derives some encouragement

(however slight) h m the fniits (howevet rare) of the supportive and heaüng

network.

According to Ergley's (1995) SISD transmission moàel, the sixth signiscant

compent determining either the grneration or resolution of compassion stress

lies in the professionai's abüity to disengage him- or herself h m the imediacy

of the victim's experience. Discussions of Uieapeutic disengagement and d t e d

uboundarks" issues by Baird (1999)' Alcom (1996), Pope and Vasquez, (1991),

Hoffman (1995), Webb (19971, Kunst (1993), Emerson and Markos (19%), Epstein

and Simon (1992), Owen (1997) and others, concur with Figley's (1995) theory on

this point all comment on the necessity of sustainhg a balance between

empathic involvement and dinical distance when functioning in the mle of a

compasionate intemenor.

The second phase of the SISD transmission mocieî, "compassion fatigue,"

(Figure 2) refers to a "state of exhaustion and dishuiction (sic) - biologicaily,

psychologidy, and socially - [ d t i n g bm] prolonged expute to

compassion stress and all that it evokes," (Figiey, 1995, p. 253). A condition of

impaued hctioning whidi is global and exûeme, compassion fatigue is l k l y to

occur when a combination of factors challenge, deplete, and evenhiaily

overwhelm the coping resources available to the professianal caregiver. Three

of the factors instrumental in the development of compassion fatigue

demonstrate the prinaple of the active transmission of trauma stress predicated

in the ÇTÇD mode1 (Figley, 1995); compassion stress, prolonged exposure and

traumatic recollections. Where compassion stress remains unadckssed,

unrelieved, and progressively inmasing over an extended period, Figley (1995)

contends that there is tremendous potential for the situation to becorne a catalyst

in the resurgence of the professicmai's own intense memones concerning

petsonal encounters with traumatic stress. Ln the event that these conditions

hanspire - regardes of the time elapsed since the originai experience of

pnimary trauma - the heiping pfessional is at substantial risk for develaping

Cornpassimate Professionais Y

constellations of impairing symptoms generaiiy associateci with diagnoses of

PTÇD, indudutg demon, hypenrigiiance, avoidance, or intrusive Uioughts

@SM-IV, 1994; Figley, 1995; Sherman, 1996).

F W y , Figiey's (1995) description of compassion fatigue acknowledges

the individual% "degree of life disniption" as the burth critical element

contributing to the condition, supporthg a growing realization that professional

functions are not performed in isolation h m the balance of the individual's life

(Figley, 1995; Lamb et. al., 1987; Anderson, 1992; Sowa, May & Niles, 1994; Pope

& Tabachnick, 1995; DiGiulio, 1995; Sherrnan, 1996; Sherman 6r Thelen, 1998;

Baird? 1999; Jennings (Ir Skovholt, 1999), and that such an artifid split shouid not

be imposed upon the practitioner. According to Figley (1995, p. W), where the

professionai helper experiences "an inordinate amount of Me disruption as a

function of illness or a diange in Mestyle, social status, or professional or

personal resp01lslWties~' in concert with those previous1y examineci impairing

innuences, it is inevitabie that critical conditions of compassion fatigue wül be the

result*

While Figlefs (1995) mode1 of SïSû transmission in cornpassionate

professionais does not Eocus s p e a S d y on issues of counsellor and pastoral

impainnent due to perçonally threatening or devastating life events? an

examination of the STSD hamework yields several concepts salient to the latter

discussim lnduded among theçe points are the following:

1) Uie uniqueness of the compassicmate professional role;

2) the incorporation of stress and coping theory with issues

of professional impairment; and

3) the identification of non-volitional stressors in conditions

of p f e s s j d impairment

A Moâel of Conment Cm*ng

Essential to an informed discussion of non-volitional impairxnent issues

within the compassionate pmfessions is an adequate understanding of the

current state of human stress and coping theory. To this end, Wong's (1993)

ment conceptualization of coping ski& and strategies ofkm a concise,

integrative perspective. Building on the foundaticm estabhhed by Lazarus and

his colleagues' influenoal explorations of cognitive and behaviourai coping

mechanimis (Lazanis & Launier, 1978; Lazarus & Folkman, 19û4), Wong's (1993)

resource-congruent mode1 of effective adaptation (Figure 3) concentrates on the

potentiai value of the personal resources (oc defiab) bmught by an individual to

any given instance of stress. In this context, "tesources" range from the non-

material factors residing within a person (problem solving abilities,

communication skills, charader traits), to relatiomhips with other people, to

tangible elements of the environment (hinds, available medical c m , d u c a t i d

opportunities). Extending tazMs and FoIkmads (1%) stress, appraisal and

coping patadigm (which de~~n'bes general elements of causal antecedents as

"personal variables" and "environmental variables"), Wong (1993) elucidates

existentid, preventative, mative asid collective coping stratepies - qualities of a

"uniqely human" adaptive capacity.

Offering a dinement of the traditional views of stress (riamely, the

tensions areated between an individual and the envionment by extemal

pressures), Wong (1993, p. 55) defines stress as my "problematic intemal or

extemal condition that creates tension1 upset in the individual and caUs for some

form of coping." Definhg the component of "effective" coping in the face of

these tensions, Wong (1993) descriibes both the long- and shott-terni benefits

inherent in the resource-cmpent appmach, Thete is, he writes, "efficiency in

tenw of expenditure of energy and reSOUTces; etficacy in achieving the d&ed

goal of removing stress and restoring balance; and personal growth in terms of

enhancing cornpetence, seIf-esteem and well-being," (Wong, 1993, p. 58). These

definitions allow the application of the present expandeci mode1 across a

specûum of life stages and situations, whether conhnting isolateci or multiple

stressorsf "garden varîety" problems of daily üving, or events of catastrophic

magnitude. FiFAy, Wong's (1993) resource-congmence mode1 adaiowledges

the signiscant inauence of cultural contexts and expectations upon an individual's

patterns of both appraisal and coping.

The function of the resource-congruence coping mode1 (Wong, 1993) is

best d e ~ ~ ~ c b e d in the context of a larger, continuous cycle of cognitive-relational

adaptations to stress (Cazanis & Foikrnan, 1%; Won6 1993). Upon each k h

encounter with a potentially stressful situation - whether the event is a novel

one, or a reauring eXpenence - the individual engages in a p e s s of primary

and secondary appraisals, evaluahg the degree of discemible ümat or present

opportunity, longevity or transience, persmai impact or detachment. At this

point, available resou~ces may be employed in the cycle's coping phase.

Given that coping is an active rather than rdective process, the

mrnpassionate professicmal experiencing inordinate stress might not make an

irnmediate and perfect match between streçsors and coping responses. Initial

coping eEorts/measures rnay, however, ' k y some tinte" for reflection and

reappaisal, while pfeparing for additionai, more effective long-tem coping. For

instance, when an unexpected and apparently mild illness occurs (e.g., "the 'flu"),

a therapist would MW/ make arrangements to rebook the weeYs clients into the

fouowing week, or to have a cdeague pmvide coverage. Either of these choices

would constitute a masonable coping plan in the event of quiring ody a couple

of sidc days away from work If, however, the duration or gravity of the ihess

causes the situation to develop pfoportions of a medical crisis, such a stop-gap

plan wouid cease to function as an overail effective coping strategy. Under this

contingency, successfui coping and comptent client care would demanci a .

accurate reappraisal of the impinging conditions, and the implementation of a

plan better matdied to a long-term absence from practice.

According to stress and coping theory, following each outcome or coping

attempt, the individuai achieves a position h m whidi to reappraise the now

alter4 conditions of stress. Depending on the nature and effectiveness of the

fesources enlisteci in the coping effort, an outcome may be judged as either

positive or negative (Wong, 1993). If stressful ciraunstances are resolved in

favour of reduceâ tensions, the person achieves a satisfactury (positive)

outcome, and Me carries on to meet the challenges of the next stressor; a proces

of growth. If, however, attempts to mach the adaptive equilt%rium fail to llessen

the stressors - or, perhaps, even e x a d t e them - an individual must rehun

to the initial phase of appraisal, and the cycle begins again.

One of the advanbges of Wong's (1993) mode1 of lesou~ce-con%fuent

CO- becornes apparent when considering the individuai's strategis for this

process of resource selection and implementation. If, through a la& of rational

analysis, an inappropriate match is made between stressor demands and the

supportive tesornes available, a personfs efforts to successfdly cope are likely

to be und-. Rather than tespnding thru,ugh skilled and infonned

strategies, coping is reduced to trial-anderor, %ope for the b e ~ r practices.

Accord@ to Wong (1993) the probability of exploiting coping skills congruent

with the challenges of the stress experience depends upon the variety and quaiity

of strategies assembled prior to the event. It is this emphasis upon the proactive

development of personal meaning (Wong, 1993) within a management

repertoire that distinguishes the resource-conpence mode1 (Wong, 1993) in the

field of stress and coping theory. Moreover, the proactive aspect of coping

presented in this model becomes paftidarly d e n t when considering issues of

the compassionate professional's respomcbility for self-care (Witmer & Young,

19%).

Case Amdications of the Won9 and Fipleu Models

Given that the value of any idea is tested and expresseâ through its

translation into concrete tenns and Wperiences, a seiection of case analyses

(Appendix, Cases #1- 4) are presented in or& to illustrate the unique application

of the models proposeci by Wong (1993) and Figley (1995) to issues of non-

voiitional impairment among compassicmate professionals.5

The case of Lorii9, a ammUTtity-based mental hedth therapist oCkrs a

c o m ~ portait concedng the development and nature of compassion

5 Illusbative case materiais presmted in the Appendix are composite profiles of several euaientic compasdonate plof8s8ionaIs. known to the author. Names, specspecific case de@ls. and other identifying information have been Jtered to protect the ptivacy of those individuais repr6s8nled.

fatigue (Figley, 1995). Louisa's &ce to sene in a field focused on wounded and

emoticmally ninerable childten presupposes her capacity to be touched by, and

act upon her concem for others,6 in spite of the o h negative environment in

which this is accomplished. The chrr,nidy stressful conditions shaping Louisa's

employment within the meneai health service are a product of both the nature of

her work, and the nature of the organization iWC Fbtly, Louisa absorbs

repeated exposures to victimized chrldren, and to families otherwise in need of

support, an activity which is a wearying task in itself (Hicks, 1993). Secondly, she

has intemaihed her identification with the public agency, which perceives and

experiences itself as undervalued, given the wueiieved inadquacies of funding

and staff required to meet the mandate for whidi it is responsiible. Like rnany of

her coiieagues, Louisa exhiits and is stniggüng to cope with several dassic

symptoms of professional bumout (Hall, 1997; Witmer dr Young, 19%; Emerson

6t Markos, 1996). Given these conditions, Louisa's work is n o d y conducted

under a considerable bwden of compassion stress (Figley, 1995).

According to Figley's (1995) dual-phased moàei, L o d s enduring

experience of compassion stress is a substantial but insuffiaent comportent in the

development of compassion fatigue. At this moment, however, Louisa has

become the recipient of secondary traumatic stress (Figley, 1995) in a manner

signincantiy more intense than her daily ccmtacts with traumatized ChiIdren,

There is usually a marked lape in thne bekween the occurrence of a chiid's

traumatizing event (or series of events), and Louisa's first contact with him or

her. That period of time is likely to ahrd Mdten and their parents severai

oppominities (whether formally or informally) to recount, review, reflect and,

6 For the purposes of this discussion. the choiœ by Louisa (and other mental haalth therapists) to work with emoüonally wounded childm and families will be regarded as evidence of positive motivations and weli-adjusted quaiities, and should not be considered as an opportunistic -vity aibwing preôatory or other patfio(oeical behaviours,

perhaps? distance themselves a bit from the events of th& stories (Hicks, 1993).

In this encounteq however, Louisa is immediately cast in the roles of both an

active partiapant and a witnes, since this diait family is in the throes of

absorbing its present reality - an horrifie, traumatic and grievous eXpenence

whichis sa UnfoldirLg.

Additionally, buisa carricarries in her own history a parallel experience of

traumatic assault Although she long ago redaimed a healthy adjustment to Me,

and demonstrates constructive resilience in the context of this assauit and other

diffidt life events, the present trauma of this family has a profound resonance

for her. Accordhg to Figley (1995), the disturt,ance of traumatic tecoUections

(experienced by Louisa in symptoms of both psychological and physiologicai

intrusions) is a critical element contn'buting to the development of compassion

fatigue.

Louisa's case does not identify the current details of her private iife.

However, several researchers and authors (Reamer? 1992; DiGiulio, 1995;

Gerson, 19%; Mahoney, 1997; Sherman 6t Thelen, 1998) estabiish the likelihood

that signifiant petsonal burdens may exist either simultaneously, or in recent

proximity, to the work-relatecl stcessoft eXpenenced by such compassionate

pro fe s s id as Louisa. Figley's (1995) mode1 acknowleâges, but does not

adequately explore this fourth aitical element as the "degree of lik disnption"

contnbuüng to the professional's risk for compassion fatigue.

According to the ciinicai descriptions offered by FigIey (1995), Emerson

and hrIarkos (1996), Wtrner and Young (1996) and &ers, Louisa is a d t y of

not one, but two identifiable and damaging syndromes: professional buniout

and compassion fatigue. The enduring, negative stresscm of her work Me,

coupled with her experience of present professiohal and historic personal trauma

have comlidatedf leaving Louisa depleted and waunded. in the wake of this

transmitted and d e d trauma, Louisa initially believes her only option for

coping - for Sunnving - is to abandon her job altogether.

Where Louisa's story illustrates Figley's (1995) specific model of secondary

traumatic stress transmission and the development of compassion fatigue in

professional helpers, the case of Pastor Craig affords some understanding of

certain aspects found in Wong's (1993) generd model of resource~~ongruent

coping. Prominent in this innovative synthesis (Wong, 1993) is the recognition

that an individual's socidturai context generates considerable influence upon

both the stressors experiend, and the efficacy of the person's coping resources

and choires. Although Wong's (1993) emphasis is primarily upon the influence

of traditional cultural elements (mmely, ethnicity, community and language), in

Pastor Craig's eqxrience the modei is applicable because his immersion in a

culture of professional Christian ministry infom and shapes the *ority of his

personal and professicmai envinnunents, induding role-congruent coping

options.

Gaig and Gnœ's personal beliefs support his vocational participation in

their faith-commUNtyf independent of the larger Society in whidi they live.

Sice the Church tends to regard its pastors as sojounneis, Caig's eXpenence

with employment placements by a process of calî7 is a major factor in the

famiy's vaned geographic and economic history. The worlr of several

mearchers (Morris & Blanton, 1994aI 1994b; Wamer & Carter, 19&; Kieren &

Munro, 19ûû; Mckey, Wilson B Ashmore, 1991; Benda k Diiiiasio, 1992) points to

this and other significant stressors eXpenenced by a majority of dergy and th&

families, in relation to the unique aniumstanœs of the ministerial lifestyle.

Aithough the demands of work frvently interfere with the enjoyment of th&

"normal" family Me, Pastor Craig's role also contributes to the network of

congregational and community supports he and Grace have developed for

themdves and th& chiîdren, in spite of (perhaps in response to) separatiom

from their extended family. According to the organization of Wong's (1993)

rnodel, Craig's pastoral experience may hction as either a resoufce or a

stressor in any given situation; moreover, its influence is Likely to operate in both

domains simultaneously.

In the context of Wong's (1993) model, emphasizing proactive coping and

the importance of spiritual/existential values in the human experience, the

consistency Craig maintains between his personal beliefs, a . his vocation as a

Christian pastor, is a signifiant factor in the deveiopment of an appropriate and

fundionai range of mphg strategies. Recent research by Fortune (1989), Steinke

(1989), Mahoney (1997), Sherman and Thelen (1998), and 0th- identifies the

7 Within the Christian community, the terni 'call" denotes both formal and informal understanding of personal vocation. tn its broadest sense, each person confesses Christ as Saviour is resgoiding to the call d the Ho(y Spirit, GIowtn in the Christian iïfe is eric~uraged as beHevers bear God's individual catl to devebp and exercize penonal talents and gitts - wnethet spiritual, physical, i~kectucil, mathm or emdiaml - for the futMerance d the Gospei, and taward the building up of other members m i n the Body of Christ. This recognition of the cal1 as a personai invitation, roated in Gob's diied invohmeM in an irdividual's Me and tnisting His putposes, is Vie mis by which some denominations exterid *ailm to include the f ~ ~ l i z e d processes of eritefing pastoral training, iMd/Or the arrangenient of the specüiic mtch between a ciefgy member and a mgregaüon for a period of rninistry.

"caretaking" of an individual's spirituai life as an element essential to wd-being.

ui Paçtor Craig's life, personal spvituaî caie takes shape in several related

plusuits, hciuding a committed p y e r and "devotional" lik, marital and family

bonds based on Bibliral prinaplesI and his authentic desire for continueci

participation in his faith-community and its coprate wmhip. Interpreted

according to Wong's (1993) resoutcesongruence model - and together with

various cognitive, physical, psychologid, social and financiai strengths - the ongoing spirituai focus of M g ' s îife enables h i . to daw upon a broad, creative

and appropriate range of proadive coping resowces when he is conf?onted with

either common or exceptional stressots.

Given the chronic and seldom-relieveà stressors attadied to parish

ministry, and its unavoidable intrusion into the normal sanctuaries of family NeI

Pastor Gaig has long been at risk for developing b o u t symptoms. Together

with these conditions, the tecent arisis into which he was drawn, and the

subsequent resurgence of mernories detaiüng his similar participation in his

father's cardiac emefgency have cornbind to mate conditions under which

Craig is now eXpenenchg secondary traumatic stress (Figley, 1995). Since, in

addition to a personal faith, Craig's effective coping repertoire indudes a

subshtial rneasure of intimate emotional support shared between himdf and

Grace, he has relieci heavily upon her strengths this past week

From the place of this already depleted emotional condition, Gaïg is now

confronteci with an addition& signi6cant crisis; a famüy bereavement bearing

echoes of previous expiences. According to Figley's (1995) confguration,

Pastot Craig is ripe fbr the impairment of compassion fatigue. hterpreted by

Wong's (1993) m d 4 the hkelihood that an individual may successfully

negotiate the challenges of a uisis is directly dependent upon the congruence

between person and resources, and betwem appropriate i.es0urces applied in

speafic circumstances. In this case, the histdcal strength of Craig's effective

coping has been moted in las active Christian faith, spousal support, extended

famdy and commtuiity. His presait circumstance of non-volitional stress is a

signifiant challenge and potential barrier to the present eficacy of those

resoufces*

Given the preceding brief introduction to the existing models of Tesource-

congruent coping Won& 1993) and compassion fatigue (Figley, 1995), it is usefd

now to focus attention on theh synthesis into a modei speafic to the experience

of the compassionate professional.

Chnpter Four

SOtlRCE MODEZSBLENDEDAND EXENDED

Brief ZWciples of niecm Dmeloment

The deveiopment of a theoretical concept or mode1 is by nature a slow

and dehkate process (SliEe Q Williams, 1995; Kuhn, 1970, ated in Figley, 1995).

It is an ongoing procedure which simultaneously seeks to interpret, challenge,

integrate, reoqanize and extend the assumptions of existing "knowledge" with

the innovative elements and applications proposeci by k h thinking and

observations. At the same time, sound theoretical developments range aaoss a

variety of abstract levels, £rom the broady philosophicai, to speafic models of

disaete functions or systems ( W e 6t Wiliiams, 1995).

The Path of Themu DaDelument Towurd the Sunthesized Mudel

A m e n t example of this theorydevelopment process may be obsemed

in the evolution of psychotrauma theory, recentîy described as a fieid "in a pre-

paradigm state" (Figley, 1995, p. 6). Although countless generations of humanity

have endureci (and surviveci) the traumas of war, naturai disasters and other

horrendous events, a cohesive portrait of such emotionally costly sunrivorship

has only recently been codifieci, and remains in the proass of rehement.

According to Figley (1995, p. 7):

the concept of PTÇD, developed through both scholarly

synthesis and the politics of the mentai health professions ... was inttoduced in the DSM:-Ili (APA, 198û) as the latest in a

of tmns to descncbe fk harmful tn'opsychosocial eficts of

ïraumatic ewnts (emphasis added).

By extension, it is apparent that the concepts detived from the primary f a y s of

psychotraumatology (inciuding those affiliateci concepts of secondary traumatic

stress, compassion fatigue, and treatment considerations or sûategies) should

aiso be approached as incomplete and developing, even as they are

cohstncüvely appiieâ in piesent ckcumstances.

Understanciuig the dynamic nature of theory is partiddy helphil when

considering the question of non-volitionai impaiirment and potential resiiience as

eqmienced by compassionate professionais. As has been demonstrated in

Chapter Two, several elements relateci to UUs issue appear in the context of other

iveas of concern, dispecsed among specialties addressing addictions, professional

competency and impairment, occupational health, stress and coping, counsellin&

trauma work and pastoral m e . However, the reviewed Iiterature yields iittle in

regard to the areas of common experience between pastors and counsellors, and

less sül l to the composition of professional impairnient as it may be conditioned

by signiscant, negative and unavoidable disniptions in the individual's private

lifè.

Also contained within the broad domain of human stress and coping, and

intersecting with concenis speofic tu both health-care and occupational stress

studies, is the concept of buniout among professional caregivers. As noted in a

prior segment of this discussion, the term "bumout" represents a range of

deterimathg conditions, extending h m work-dted malaise to the

contemp1ation/completim of suicide. Bumout develops gradually, as the

individual experiences chronic and unrelieved (intense, but not Me-btening)

demands relaied to the functions of professionai caregiving (Figiey? 1995; HaU,

1997). Recovery h m bumout is noted to be an equally slow process (Fidey?

1995). Considering the similar contexts in which the professional functions of

both clergy and counsellors are perfomied, the concept of h o u t as drawn

h m studies of occupational stress and coping, provides an important source for

the development of a model of non-volitional impairment and tesilience.

Also ckwsed in depth elsewhere is Figley's (1995) addition to the existing

dinical portrait of PED, a dual-phad malel dernomtrating the transmission of

secondary traumatic stress and the development of compassion fatigue in

professionals working with victims of ûauma. Figley's (1995) mode1 offers both

structure and content to the present consideration of the non-volitional

experiences spepfic to clerics and counsellors. His treatment of compassion

fatigue as a syndrome distinct from the spectrum of burnout is aitical to

unders tanding the qualitative, ra thet than qyntitative, nature of non-voli tional

impairment. Furthet, the model (Figley, 1995) Aows for the complexity of

arcUmStances in the compaseionate professions which may generate

syndironous, rather than exclusive, conditions of bumout and compassion

fatigue. In the context of non-volitional irnpaiments parti& to the @ence

of pastoral and CO- professi~nals~ one of the most signiscant components

of Figley's (1995) model is found in its (iimited) recognition of the influence of

"private Lik" disniptiom in the development of compassion fatigue.

Fuiailyf in d e r to adequately infoim a specific model of non-voliticmai

impairment in the compassicmate professions, it is necessary to examine the

current context of general professionai impainnent issues. As demonshated,

several definitions and considerations fiaming impairment concerris are

encountered in 0th- disciplines such as medicine, nursing, and social work A

review of ihis broad information reveals that the majority of material is occupied

with prob1ems of addictions, questions of professional competency, abuses of

power (usuaily semai behaviours), the detection and treatment of such

problems, and the accountability of colleagues in the aforementioned

Orcumstances. The same survey of available liteature is evidence of the scaraty

of comparable materials speafcally dealhg with c o d o r s and pastors.

FuiallyI aside from a few recent studies, the literature's treatment of professional

impairment due to unavoidable and distresshg circumstances in the individual's

private iife is almost wholly confined to authors of the psychdytic schools

(Schwartz & Silver, 1990; Gold & Nemiah, 1993; Gerson, 19%). This absence of

deveioped theory in the professional literature has been identifieci as an issue

tequiring carefd artaiysis and concephial synthesis, in order to geneate

construcüve applications for the %al world" experiertces of compassionate

The logid points of depamire to this present extension of the field were

derived h m the models proposeci by Figley (1995) and Wong (1993). These

models have functioned in parallel, but without putposetul and obvious

integration concerning the assessment of counseilors and pastors at risk for

impairment due to non-volitional factors. However, when evaluated in light of

Wong's (1993) emphasis on the value of "proactive versus reactive" copïng

strategies, and "effective v e ~ u s ineffective" adaptations, a minor but wful

extension of Figley's (1995) focus on the hazard of impairment generated by

compassion fatigue becomes apparent, Set in the contact of non-volitional

peftonai and professional impairment as it is eq~+rnced by c o m p a ~ m t e

proféssimfs, this augmentation of the combined models extends the element of

compassion fatigue (Figley, 1995) to recognize "compassion dence' ' as an

alternative and desirable outcorne in such an instance (Figure 4). It is an

extension consistent with Slaikeu's (1990) general discussion concenùng the

effects of crisis

we must rememk that h m the disorganization that

ensues, some sort of reorganization must eventudy begin.

This reorganization has potentiaî for moving the person... to

higher as well as lower levels of functioning. At first glance,

gowth resulting fimm something [traumatic]..siay seem

rather farfetched. However, since these events call for new

methods of coping and provide the occasion for examinina

and reworking umsoIved personal issues ftom the pst,

it is passile for an individuai to emerge h m the aisis

better equipped than before to face the hthue, (p. 65).

Resilience B r k t b Defined

Resilience, by definition, suggests the quality of enduring strength

Encountered in the naturd and physical sciences, resilience describes the ability

of an mganism, substance or system, subjected to extreme and/ or prolonged

stress, to retain, recover, or enhance its Onguiai form, once the sttessor

conditions ate lessened, removed or assimilateci. h some instances, this ability

to suMve may be the result of adaptive capaaties inherent m the original form:

the elastiaty exhibited by certain plant and animal tissues ofks a simple

example of this. In other cases, d e n c e is achieved through the unique

combinations of cm&tions created in the hision of particulat stressors and the

origmal forni. The simplet iîlustration of this principle is observeci in the na-

world where, under speafic stressor conditions of pressure, temperature and

time, akssed deposits of the element carbon are transformeci into the crystai

structure better known as diamond. Nothing of the pure elemenfs nature is lœt

in this transformation, but its potenoal applications are drastically altered, and its

new substance-Eonn acquires a brilliance, darity and strength not possessed

prior to the influences of the combineci stressors.

Explanations of individual human d e n c e have traditionally adopted

simüar illuskative models b m natural-worfd examples and parailels,

partidariy as the field has focused on explorations of personality traits that are

hardy and stress-resistant (Wong, 1993). However, where the physicai sciences

simpiy explain tesilience as the equilbrium (or "homeostasis") achieved through

the conservation of matter, or via systemic adaptations, the approach is one

increasingly recognized as insuffident to explain phenontena of psychological

CeSilience in people (Hoff, 1995). According to Hoffs (1995) dixYssion of aisis

theory, "several limitations [exis t] to the concept of homeostasis as applied in

psychology and psychiatry. For example, honieusthsis does not qp2y to processes of

grauth, &velopmuntr creatiott and the l~k,'' (p. 1 2 emphasis added).

Given this emphasis on the qualities of human transcendence - qualities

which pmvide Surpivors with something beyond the element of simple physical

continuance - it is not surpriPng that psychoiogical resilience is o h expresseci

in language refiectmg the Lheolopical, clinical and poetic. Thus, Frank1 (1959,

1962) discusses the endurance of the human spint in the face of inconceivable,

unbearable and dehumanking conditions. Wong (1991) writes of the higher

purpose fauid thmugh suffering, and (1993) of a "vasi guler m e " of

creative, spintual and psychoIogical resowces that support the individual in spite

of Me stresses. In a similarly spintual tone, Hicks (1993) points to the sustainhg

hope of trauma s ~ v o r s compeued to endure, if only for the sake of the

meaning investeci in their personal relationships. Biblicai passages speak

repeatedly of the spirit of enduranceI strength in the face of adversity,

perseverance, patience, and the building of a character of excellence in the

believer (Joshua 1.9; Proverbs 31.10; Romans 5.1-5; Coloesians 1.10-11; 1

C ~ t l l i t h h ~ 4.10-13 & 13.47; Psalm 46.1-3; 2 Corinthians 4; Phüippb 4.49; 2

Timothy 2.810 & 4.5-8; Titus 2.2; Hebrews 10.36; 1 Peter 2-19-23; 2 Peter 1.5-9;

James124 Q 1.12. New hternational Vexsïon). Less poetic, but equally

persuasive, is L,azanis and Foikman's (1984) reference to the existence of flemiie

cognitive styles which cm accommodate aberrant expiences in a human Me.

Although expressing the central W p l e in a variety of descriptors, each of

these wrîteis is in agreement with Hoff s (1995) position that the quality of

resilience is a dimension of the human experience that cannot be accounted for in

simple medranistic terms.

Considered within this trame, and as suggested by the present model, the

likelihd of movement by the compassionate professional toward either fatigue

and subsequmt impairment, or d e n c e and growth, is one sllIIttnarized in

Spedrhard's (1947) staternent:

Studies of the cornplex nature of trauma-reiated vulnerability

and resiliency have highlighted the fact that individuab respond

differently to potenüaiîy traumatic eXpenences depending

u p n previous eXpenence, context, and acpectations. In other

words, the meaning of any given Srpenence can vary 8featIy,

not only from one individual to wother, but significantly over

the duration of a given individual's Metirne. Thus, given the

appropriate context and the idiosyncratidy necessary

antecedent priming eqmience(s), vimially any experience

can have traumatic impact, even retrospectively as new

eXpenences d w g e the meanings that are assjgned to previ-

ousiy experienced events, (p. 68).

Wons & F i ' Intertrreted Z7t~oudz Case Materials

When assessed h m the combineci perspectives of Figley (1995) and

Wong (1993) (Figures 1 dr 2; Figure 3), the cases of Louisa, M g , Ridiard and

Katriona (Appendix) iUustrate the distinction of non-volitionai stressors and

impairment risks for compassionate professionais. Whüe it rnay be argueci that

no one of these instances presents an htration of "text-book perfection" in

which the criteria for compassion fatigue (Figley, 1995) are met in their entirety,

each case clearly indicates the severity of risk surrounding the piofessional

involved. For instance8 Louisa's situation rdects the highly volatile combination

of secondary traumatic s-, prolongeci exposure and traumatic recollection

that is the heart of Figley's (1995) compassion fatigue modd Additiody, she

pmsmts as a professional already eXpenencing the erosive effects of

occupationai bumout (Emerson & Markos, 19%; Witmer & Youn& 19%; Figiey,

1995; Sowa, May & Niles, 1994; Rearner, 1992). For the purposes of simpliaty in

this discussion, it may be assumecl that events in Louisa's personal life remain

relatively stable at this time; however, even without signin.cant disruptions in ttiis

area, the previous elements are more than SuffiCient to place her at risk for non-

volitional impairment,

In conhast, both Gaig and Katriona are encountered at the point of

eXpenencing extrerne Me disniptions, both interrupting and combining with

their mies as compassionate pfessionals. Bearing traditional burdens of

pastoral are, Craig also has ment and direct involvement in a critical event,

with the addition of pexs0nal.i~ traumatic mernories revived by it. An even more

signifiant event, a famiy lm, has subsequently oc~tllfed at a point where Craig

has not yet recovered h m the effecfs of the commUNty event. Even without

the presence of Figley's (1995) element of prolongeci exposure to others' tauma,

Craig's present constellation of events strongiy points to the developrnent of

conditions of compassion fatigue.

Similady, although Katriona's case does mt indicate an awareness of any

personaily traumatic recollectio~~~ compounding her di)fidties, she has a

personal history marked by prolongeci expomw to victims of trauma and the

eff& of their experiences. According to Figley's (1995) mode1 this viarious

eXpenence places her at considerable risk for the syndrome of secondary

traumatic stress. F l V f h m o ~ ~ the sudden intrusion of this siflcantly

distressing peftonal event, in the form of serious ill-health, exacerbates

Katriona's set of conditions beyond the maches of "simple" stress or bumout,

and moves her into the comp1exities of compassion fatigue.

Finally, aithough Richard's clinical experience lacks the accumulation of

"pure" secondary traumatic stress (since his campus-based practice is not

primarily comprised of trauma survivors), his present working conditions point

to the certain eventuality of burrpnit, compassion stress? or both Compounding

this is the ment death of dient D., an event encompassing both immediate and

past trauma for Richard. Memories of previous professional encouiters with

suicide, and his own si'bling's intentionai death are revived by this ptesent reaüty.

Viewed coUectively in the context of his ongoing work, and incongruent and

deficient coping chaices, the elements of Richard's experience also mate a profile

consistent with the path to compassion fatigue.

When a s s e 4 according to Wong's (1993) mode1 of effective coping, the

case materials continue to offer insights useful to understandmg the

development of compassion fatigue and non-volitional impairment, and

(equaüy), compassion d e n c e in compassionate professionals. Although

Louisa's case presents iiffle information regarding her speafic, personal

repertoire of coping skills, the elements of appaisal pn>cesses and resou~ce-

congruent choices emphasized in Wong's (1993) mode1 are dearly evident in the

supports recentiy estabLished in Louisa's extremely difficuit professional Me.

Similarly, Craig's situation is an example of personally and s i t u a t i d y

congruent coping resources, and of simple but effective coping choices. Wong's

(1993) element of cultural context is applicable to Craig's case where it recognizes

his participation in a very s-c su-ture of faith and profession, which in

tum influences his selection of copins skills (inciuding his family Ne, spintual

disciphes and social values).

Katriona's story iliustrates an extensive repertoire of balance a .

resources, including purposeful spintual stffngths and activities, a range of

physical and exnotional selfi.are measutes, creative outlets, and the continuhg

development of her profession and ethics. Additionally, Wong's (1993) element

of adturai context is relevant in the evaluation of Katriona's resources. Aside

from the influences of the iarger d e t y in which she lives' Katriona actively

identifies herseU with s e v d separate (but co-existirig) "su&culturesn. These

sources of potential assets include her Christian community, a professional

culture disthguished by compassion, a mal social comnunity, and a womens'

culture shapeâ by the gender-issues present in al l three of the previous pups .

In contrast, the application of Wong's (1993) model to Richard's situation

reveals significant defïats in a comprehensive strategy for aturce-congruent

coping. Although the details of Richard's style of selfare and professional

maintenance previous to this period are not Speaned, his disproportionate

reliance upon external and transient sources of support (busy schedule, physical

environment, student contacts) is apparent. Additionally, since learning of the

death of his dient, Richard's actions have been more demonstrative of

dysfunctionai and ultîmately ineffective reactions, than of purpoeehil appraisal

and responsive coping measUres. Rather than seeking and exeKiPng the

supportive measures he would recommend to a dient in similar circumstances

(e-g., debriefing the crisis srperience, peer support and self-care), Richard has

chosen isolation, rumination and dcohoi to deal with his emotional distress. The

outcome of the path of Richatd's present s<peiience is not likely to meet Wong's

(1993) criteria of positive stress resolution, namely, reduced stress, restored

balance and enhanced well-being.

Retuming to the case of Katriona, it is readily apparent that her current

personal crisis is inextricably linked with her characteristic appmach of proactive

pbiem-solving. However, her awareness of the ptob1em should not be

conhised with aeating the present crisis. It is Katriona's appraisal of recent

syrnptoms as a challenge worth adàressing that has prompted her to adjust her

plans for preventative health care to "sooner,'' rather than "later". By this

response she has leamecl of an existh& threatening, but previously

urtrecognized, pathogenic condition. The timing of this information, however

distressing and unwelcome, may achcally function as a resource in Katriona's

management of her moment of personal threat and crisis, and its potential

outcorne. In contrast, while his practice arnong University students certainly

requires him to coach others in the application of realistic appraisal and coping

skius, t h e is Little evidence to asmune h t Richard consistentiy functions h m a

position of congruent problem-sohing for himseü. In fact, he regards himself as

thriving on the overload of his professional activities, relying on the energy of

his youth and physical condition to sustain him, rather than mauttainhg

teasonable boundaries and expedations. For Richard, the la& of an intentiody

proactive orientation in bis professional life weighs as a signifiant negative in

the balance of his resource options.

According to the present synthesis and extension of the Wong (1993) and

Figiey (1995) models, a variety of potential outcornes, both positive and

negative, are likely in each of these cases. It is possible, but by no means certain,

that Lowsa's experience could conclude poeitively following the restorative and

supportive interventions proposeci by her superim. Ctaig's ability to manage

successive personai crises in the context of a ta>ang miniskry is severely

challengeci at this moment, since his primary supportive cesou~ces for coping

(faith and Emuly) are now fully enveloped in the same experience of crisis. In a

third situation, Katriona demonstrates strong potential for eventually atriving at

a place of compassion d e n c e , but this cannot be considemi a foregone

conclusion. By cornparison, Richard is a lücely candidate for professional (if not

global) impairment, given the conditions he has both encountered and

cansbucted.

In order to more completely understand the path to either fatigue (Figley,

1995) or resilience (Slaikeu, 1990; Speckhard, 1997) that lies before these and

other compassiortate profkssionals in distress, it is necessary to examine the

individual componaits and interactions in the synthesis and extension of the

models off& by Wong (1993) and Figiey (1995). Essential to this task is the

distinction between the levels of global ("wholepefton") trauma processes, and

discrete medianisms (or "seiective") trauma processes. This synthesis focuses

upon the former, adopüng an approach of integrateà appraisaî, rather than

examining individual strategies of coping.

Non-Volitional lmvahen t and Resilimce in Com~assionate Professionals:

A Mode1 - Figure 4 is a schematic presentation of the mode1 descriiing Non-

Volitional Impuiirnent and Resilience in Compussionatc Rofes s io~ l s . The

diagram coflsists of eleven interadhg segments. While the rnajority of these

have been àrawn h m Figley (1995) and Wong (lm), the principle elements

asnime narr0we.r definitions, and new functions or effects when integrated in

the present context As shown in the figure, the individual elements follow

dosely the configurations set forth by Wong (1993) and Figley (1995), inciuding:

1) SpeaScCLXltural context

2) congruent remmes repertoire

3) secondary traumatic stress

4) p l ~ g e ~ e x p o s ~

5) traumatic recoHection

6) non-volitional Me disniption

7) previous dysfunctiod copLig

8) integrated appraisal

9) integrated coping

10) ineffective/ inadqate mping

11) 1- to growth (compassion fatigue, threshold maintenance,

compassion d e n c e ) .

Svedfic Cultural Context

Foundational to this model is the segment labelleci Spe@ Cultural

Context (1). This k t element is a signifiant contriition from Wong's (1993)

work on resource-congruence in effective copuig. It is a g e n d designation for

the effects of s o c i o c u l ~ influences upon the individual, including situatiod

interpretations and expeaatiuns, communication methods, &al roles, and

ethnicity. Depending on the given ckumshnces, the individual's cultural

conditions and resources may have a -cial or detrimental fundion. As a

broad example, consider the event of an unplanned teen pre8naclcy. According

to the focus of Wong's (1993) cultural context, this lhchanging wmt is likeIy to

be a significantly difkrent eXpenence (in some respects, at least) in the

perception of a kt-generation female member of a ChineseCanadian family,

than for a fifth-generation female m e m k of an Anglo-Canadiian hmily. The

same situation will likely be difkrent again for a young woman daiming an

Aborigmai hentage, with its attendant m y system. In the first instance, where

Asian family culture is commonly dominateci by a collective and cross-

generational orientation, there is lücely to be tremendous emphasis on family

honour and filial okdience (Sue dt Sue, 1990). A First Nations family may

operate within a similarly communal petspective, but - occupying a distinctiy

different d e and status within the broader society than new Canadians usually

do, and possessing a Mering vision of spirituality - may hold sigriiticantly

different beliek concemirtg meaning and outcome(consequencesI t.esolutions) in

this situation. Young women h m Angle-Canadian families, dthough perhaps

also mind)ul of the value of advice hom elder family members, are less Likely to

feel the cmtraints of those elder members' wishes, since the general orientation

of most families of "Western" descent is decidedly more individualistic than is

found in o t k dtures.

A narrower interpretation of this basic definition of dtural mntext is

applied as the +fit culficral context in the present model, through the

recognition of unique professional and religious citcumstanœs in which

therapists and dergy encounter and meet the demands of theV vocations. As

noted elsewhere, counsellors and cl& both Scpenenœ, and are perceiveci by

others to operate within a rarefied environment, whem the blending of private

and professional lives is virtually inescapable, and expectations of performance

are kquentiy unreéîiistically high. u\ genetal, their colleagues who work in

professions which are equally compasionate, but more technidy- or

institutiOnaUy-oriented (e.g, medicine, nursing, emergency response work), are

less îikely to be subjected to constant "invasions" of the sanctuaries of private Me

by the demands of th& professional cultures.

Additionaily, as professional caregivers hurctionhg within communities

de- by the tenets of Christian faith, ptors a d cowselioss who engage in

"cive" ministries are likely to encounter distinctively SUWU expectations

regardhg behaviour, emotions and resources. Gemrally comidered as mms

within the "community of beiievem", these s<pertaticms are usually believed to

cany an even pater weight of morality than do those expectations simply

p m a i i i by good professional ethics. At the same the, sub-cuihual

comUNty expectations are ohen considerably narrower, and less flexible, than

are the accepted n o m of the l q e r Swety.

The appended examples of Couisa, Cr&& Ridiard ami Katriona illustrate

some facets of the subcultures, both religious and professional, in which pastors

and therapists function. In oder to comprehend the unicpe position of the

compassionate professional at risk for eWpenencing non-volitional impainnent, it

is essential to derstand this extendeà definition of the speciflc mftitral context,

since it bears on ai l subsqent elements and interactions in the synthesized

model.

The second dement of this model, also derived tram the murce-

conpence work (Wong, 1993), is the Congrumt Remurces RepPrtoire (2)

constructed by the individual, Won@ (1993, p. 58) description of personal

resoun:es as those "devices and means of supply that can be drawn on in times

of need," indudes the traditional physid and cognitive aspects descn'bed by

such researchers as Lazanis and Follmw (1984) and others, with the addition of

collective, creative, existeritid and SpLitual components. Accotduig to Wong

(1993), resources exist in community; the proactive development of them in that

context, rather than in isolation, can offer an individual tremendous strengtks

and options in coping with stresshil ciraanstances. Wong (1993) hirther attends

to the necessity of conpence between tesources and demands, emphasizing

the pmactive nature of resource development. The concentration of Wong's

(1993) model upon the individuai's spiritual resourcesI and efforts to discover the

meaning of existence and sufkring are particdar1y signiscant in the case of the

pastoral or counselling professi~nal~ aupenting and shaping that cmgruent

resourcps repertoire, plcesumeci to be developed through professionai and

continueci training peer nehnrorks, experience and personal resowces.

Secondm Traumatic Stress, Prololtzed Emoswe and Traumatic Recollections

The next three sections of the present synthesis, Secondary Traunatic Stress

(3), Prolonged Exponcre (4), and Traumatic Recollections (S), originate in the second

phase of Fiey's (1995) compassion fatigue model, and iargeiy retain the

definitions and funcüom applied in that source. Sewnàary hmcmatic stress tefers

to the compassicmate professional's vicarious experience of, and victimization by,

painhil or feathil events endured by othet people, when related by them in the

course of crisis intervention, therapy, or pastoral care. In the present mode1 as

in Figley's (1995) definition, SIS may be the effect of either a cumulative or

isolateci witnessing, and absorption, of such material.

The case of Louisa offas a simple example of SI'S in the mntext of the

couIlSellor's movement toward either compasion fatigue or resilience. Whereas

the desujibeâ encounter with a traumatized family could in itself constitute

suffident dtical acposure to pcecipitate SLS in Louisa. her multiple and long-

term exposures to si* case material hilfüls, for her, the a d d i t i d dimension

of prohged exposure, recognized by Figley (1995) and serving the same hinction

in the present modeL In simple terms, the sheer weight of repetitious contacts

with haumaüzed surPivors is a risk factor for the compassiortate professional. It

is the position of the present model that prolonged ~xposure wili resuit in similat

effects, whether those contacts take the form of:

* multiple short-term exposufes (as might be the case of a

commmity c o ~ m speaaliPng in work with SUrYivors

of wual assauit);

limited numbers of continuing-care clients who have

survivecl extrerne trauma (as might be the case of cou~lsellors

çpeaaüpng in work with refugees b m war andlm phticai

torture);

or a mixture of both short- and long-term trauma care

(as might be the case of pastoral and therapeutic caregivers

following a community trauma/dkster such as a tomado,

or an incident of mass violence).

The Eitth segment of the Non-Voliti-1 Intpaiment a d ResiIkco model,

Traumatic Rewilecton (51, is also extracteci h m Figley's (1995) innovative

paradigm, and is supported by SpeckhaFd's (1997) analysis. Depending upon the

resolution of earrier eXpenences, the compassionate professional's remembrance

of persmal encounter(s) with traumatic cjrcumstances and swvivotship may

exeKize considerable influence in the progression toward eîther htigue or

resilience. The deciding factor appears to reside in the contactual teference of the

traumatic rewUectim: namely, whether the past incident exists as a processed

(albeit painful) memory of past trauma, or whether it possesses qualities of a

presently active and intnisive event. Inadents of onpinai tauma which have not

been successfuily subsumeci into the kger balance of Me, h m whidi the

inunediacy of exnotional involvement lingers, or which have generated related

and enduring PISD symptoms, are likely to Uiterfere with, or at least negatively

influence, the processing of the unique realities involved in the current trauma.

The power of trmcmatic recollectrotls to shape perceptions of present reaüty, and

therefore both present and future coping patterns, is illustrateci by the cases of

Louisa, Gaig and Richard.

Non-Volitional Life Disrrrrrtion

An essenaal element of this mode1 emeges in the segment Non-Volitiotl~l

Lifé Dinuptia (6). It emphasizes a cornponent acknowledged, but accorded only

minor attention in Fidey's (1995) conceptualization. In his original context of

"degree of life disruption", Figley broadly contends that a professionai's plunge

into the impairment of compassion fatigue is vimially guar,anteed if, in addition

to conàitions of STS, prolongecl exposure and recoilected trauma, "the helper

experiences an inordinate amount of Me disniption as a function of Unes or a

change in lifestyle. social status, or professional or persanal respomi'bilities,"

(Figlq, 1995, p. 253). Research finidings by DiGiulio (1995), Mahoney (1997), and

Sherman and Thelen (1998), enurnerate quivalent categories of life events that

may either hinction as, or contnhte ta, sources of distress among clinicians*

These conditions indude (but are not limited to): bereavement and grief,

and emp10yment adjustments, trauma and post-traumatic stress? relationship

diffidties and divorce, legal prob1ems, and generai likcycle transitions.

Sheffield (1998) similarly identifies broad groupings of physical, mental and

situational factors as causative elernents in the development of coumeNor

impairment.

In the context of the model off& heie, the intefpfetation of a disruptive

life experience is made within a more limited focus than has been adopted by the

previou61y ated t h d t s and researchm. Within the parameters of the

compaasionate professionai's non-volitimial life dimption, the definition of

"disruption" is retained. consistent with its common meaning in the sense of

disorganization, &turbance, or "disequiliifium'' (Lazanis & FoIkman, 1984).

The terni "non-volitional" speci6cally conveys the nature of the life event(s) in

question as adverse and unavoidable, undesirable, outside the election and (at

least initially) beyond the conho1 or influence of the person in distress. Only

briefiy addresseci in Figley's (1995) compassion fatigue mode1, that theorisY s

definition of this critical degree of disniption is necessariiy vague, an ambiguous

measure of the "inotdinate amount" of personal distress bearing upon the

individual. Because quantifiable standards are unattainable at this stage of

concephialization, the present model is similariy lacking in precision: events of

n a - w l i t i o ~ l lifi dimptim belong to that category otherwise descr i ï as

"random", "significant", "catasûophic", "dwastating", "aitical", "damitous",

or "disastmusw. Under this purposefuily narrow definition, the case histories

presented in the Appendix ofkr dear illustrations of just a few of the vast array

of life events that could mnstitute a critical m-wfitimf lifi diwon in the

aCpenence of the compassicmate professional

Conversely, there are those dismptive events of historical impact (e.g.,

encounters with violence/abuser or serious personal rUness) that may be better

accounted for by other segments of the model, (der to Cagru~nt Resources

Repertoire (2), or Trmmtic Rewllectons (5)); therefme, the focus of this element is

upon circumstances in the context of the individuai's irnmediate or cecent

experience. The limited parameters describeci in the present synthesis

purposefully exclude several further potentid sources of Me àisrupticm

(spedically: transient phases of Me; &ai stahis; generd occupational stressors;

conditions of seif-comhuction or deconstruction; substance abuse and addictions,

and generai stresses of living), since they are topics more than adequately

addressed ekwhere in the literaturp.8

In conmete t e m , non-volitional lifé dimcptions which either contribute to

the composition of compassion fatigue, or become instrumental in the

development of its counterpoint compassion resilience, are seen in such random

events as:

death and bereavernent @iGiulioI 1995; Hoff, 1995; Slaikeu, 1990)

personal (or family) aperience of serious medical condition(s), not

otherwise accounted for (ûiGiulio, 1995; Çlaikeu, 1990; Philip? 1993)

cornrnunity- or other large-scaie disaster(s) (Hoff, 1995; Slaikeu, 1990)

personal encounter(s) with, or witness b, violence (Hoff, 1995; Figley,

1995; Slaikeu, 1990)

involvement in, or witness to, other traumatic circumstances (Figley,

1995; Hoff, 1995; Slaikeu? 1990).

The extension of Figiey's (1995) original "degree of life disniption" to the

8 Aîthougn psychiatrk Cnsocders, such as the dementias or pemnaTRy disorders, alço met the stated bigniri - adverse - unmMWe' criteria, they are ercckded from the pcaserit mode! for rees~cls

o O c o n p ~ i b e y o n d t t i e ~ o f t h i s u r o r l r -

problem of non-volitional impairment in compassionate professionals M e r

tecognizes and accommodates associateci issues of intensity and duoniCity active

within the disniptive circumstances. Singular non-volitional events or conditions

(which in and of themselves might not mate impairing levels of distress in a

pason's Me) may, by Wtue of chronic recurrence, la& of resoIution, escalaüng

dernands upon resources, or a combination of these, exceed the individuai's

threshold for tolerance, and contnïte to a SigniEicant disniption of normal

functioning. A comoniy recognized example of this int&ty/chronicity factor

ocrurs where serious (but not Me-threatening)), and/ or persistent heaith issues

intrude upon an individual's Me. In its initial stages, such a pmblem might be

experienced as a relatively minor, perhaps incidental, event. However,

CiKzUmstances may d a t e to aeate a signiticant life disniption when health

deteriorates swiftly, or if the= is a lengthiy continuance of the condition and its

attendant treatments. The appended cases of Gaig and Katriona iliustrate

slightly different aspects of this intensity / chronicity dynamic within non-mlitional

lifi dimptioas, in this model of the compassionate professionai's expience.

At this stage in the constniction of the synthesized model, it is necessary

to consider the effects of the individual's histonc patterns of coping. Whereas the

pteviously discussed segment, Congruent Rcsources &?peTt~*~e (2), focuses on the

positive employment of peftonally- and situationally-congruent resources and

developed skills, P T ~ O U S Dysfunctzhuf Copnig (7) recognkes isolated or

accumulateci prior choices which have had, or continue to have, effects that are at

best "non-constructive" and, ai worst, detrimental or destructive. Given these

parametter, this segment encompasses problems of substance abuse and

addiction; aggression, violence and abuses of power; eating disorders and related

patterns of seIf-harm; and other c h r o W y avoidant, escapist, or risk-taking

behaviours.9

The aitical point to understanding the present model lies in the

recognition that previms dysfinctional coping choices are distinctly different h m

the identifieci do& of non-v01iti~l I i f e disruptions. Where the synthesized

mode1 has defineci a non-volitional disniptor as an event, ciraunstance or

condition that is signifiant, adverse, unavoidable, undesirable and apart hrnn

the influence or control of the individual, the genesis of a dysfunctional coping

choice (tegardiess of the evenhial wverity of distress or disorder) is not a

andom influence, but resides in an historic act of volition, or dmice, and may

t hdo re be better described as a leanied or aasWated behavim. Uearly,

exisûng patterns of dyshction coping exert substantid influence upni

subsequmt coping choices, and must be coclsidered in any analysis of impaireci

professional behavim. in the context of this model, however, cydic dysfunctiun

is not a source of andom non-voiitionai distress among cou11sellors and clerics.

At the same the, it s W d not be discounteci that the events, choices and

behaviours which constitute this model's domain of prmious dysfudm1 roping

may, in fat , effectively contnite to the cmpent resources reprrtoire previously

identified. Howwer, this eff& does not usually axiur unol after the passage of a

sigdicant Hod of the, or until an effective waluaticm has been precipitated

9 ~ i t C s ~ e d t n a t s o m e p a t t s r n s d b e h a v i o u r ~ ~ m a y , infact,arisefram the speelfii and decCdedOy 'm- fadm d enduring psychiatrie or orgmically-bssed disordecs, it is beyond the scope of ttiis d l s c m to examine each iristarice d Èhi tikeiihood. Pubifshed bfaîure is only beginnlng to r q n i r e üte c a p M t y ad dualdia~mis issues, wtme paychhtric condiiiocrs (othef man addictions) coaM in the and funcaoris of mental balth practiaoners. At the point of the pmmt msearch and mode1 syntheb, paralid investiOatbrrs regaraing pastmi imQannent b y r e a s o n o f p e & W a û k P l l n e m s a r e ~ ~

by another crisis. A cornmon example of this process may be illustrateci by an

addicted individual's choiœ for sobriety and personal accountability for his / her

behaviour, following an event of critical pmportions which was direftly

predpitated by the volitional impairment For the mœt part, however, the

individual's selection of (or default toward) unhealthy, inadquate, and unhelphil

methods of coping is more ükely to contribute to unstable res01utior\s, a d the

eventuai repetition of similar choices, enacting a cyde of crisis, inadeqyate

a+ and dysfunction This simple cyde is deriveci from contemporary crisis

theory, parfjdarly as interpreted through Hoff's (1995) multi-faceted Crisis

Paradip. The fourth level of that model suggests that the resolutim of crisis

may be assessed as either a positive or negative outcorne, where the latter

encornpasses emotional or mental disturbances, violence against others, self-

destruction and addictions (Hoff, 1995). With the exception of psychiatrie

disturbances, this same taxonomy of negative tesolutions is presented in the

m e n t synthesis as the accumulation of questionable, and essenaally

detrimentai choices made by an individual prior to immediate ammistances of

hmntlttk recolkecttons, Iifi distuptions, or prdonged e x p m r e to secondllry traumatic

stress.

In the context of the presmt discussion conœming the development of

non-volitional compassion fatigue, the collective inauences of prEmous

dysfunctim1 cqing strategies are speafically acknowledged, in recognition that

prim choices may be instrumental in the development of current circumstances.

They are not, however, the primary focus of the present âhussion,

The next, pivotal, segment of the synthesized mode1 focuses on the

significant tasks of lntegrated App~aisrtl(8) which the compassionate professional

at risk must eventually consider. Whereas traditional models of stress and

coping (Peacodc & Won& 1989; Wong, 1993; L a z m & Follanan, 1984)

emphasize the seledive "mechanics" d such evaluative tasks (e-g., leveis of

primary and secondary appraisals, feedback loops, objective measures of stress),

the focus of the pteçent modeYs attention to iintegmted appraisal is upon the

bahce of personai and professionai perspectives of appaisal. The area of

personal appraisal refem to questions of individual meanhg and attribution

(Fr&, 19591 1962; Wong, 1991), the problem of pain (Grunebarn, 1993), the

recognition of growth oppomimties (Famsworth, 1998), and simiiar existentid

challenges created by sigiuficant Qrcumstances of non-volitional distress (Phiüp?

1993; Wyatt-Brown, 1995). Parailei to this, the range of professional appraisal

encompasses matters of accountability and ethia (Andexson, 1992; Skompa B

Agresti, 1993; Pope 8c Vasque, 1991; Gibson 6r Pope, 1993; Pope & Tabachnick,

1994; von Stroh, Mines & Anderson, 1995), clinical evaluation (Coster &

Schwebel, 1997; Webb, 1997), achievement or disengagement (Figiey, 1995), and

the professional's respomities for seif-care (Muse &z Chase, 1993; Pope 6r

Tabachnidc, 1994; Sperry, 1993; Witmer dr Young, 19%). It is in this emphasis of

perception and context, rather than speafic passes of appfaisal that the

segment integmted qprais112 fepfe~ents a critical point of consolidation of the

source models in thb synthesis.

with the material pnsmted in the pfevious segment, where the tasks of

integrutcd llpp~aisal are defined. In the compasgio~te professional's @ence of

the effects of a m-vditional lifC dimpfion, the process of integrated coping

repmsents a broad band of potential response areas, incorporatirtg a traditional

focus on a variety of c e g mmechanisms and strategies. The domain of

intwated coping d e ~ ~ l h e s multiple levels of response areas which, depending on

the individual in cpestion, may operate in isolation, seqyence, or unisoh

Personal and professional coping encompasses the individuai's efforts toward

seif-management; management of the events or conditions created by the

disniptive intrusion; antiapatory-proactive and precipitous-reactive coping

efforts; and immediate, ongoing, and long-tenn coping strategies. This macro-

perspective of whole person trauma processes (represented in the segments

integnted qpraiwl and integrated wping) prrsumes fluidity between the coping

activities identified here, and of the time progression involved in this segment of

the model. Altemating andior repetitious movements through the areas of

coping are to be expected, depenâing on the individual's ongoing assessments of

cfianging dmunstances and remmes. The possiwties within this phase of

integrated coping are further multiplieci when considemi accotding to Wong's

(1993) assertion that congruent coping indudes resources avaüable to, and from,

both the individual and the community. The pmcesses of integrated coping

whîch occur in this phase occupy a critical role in the continuance of the model, as

the compassionate professional moves toward the condition of either

compassion fatigue or compassion resïlience.

The multi-layd activities of integmfed coping are well illustrateci in the

case of Pastor Craig. In the period foîlowing the news of his father-in-lads

death, Craig is witnessed engaging in several simultaneous coping activities,

involving both personal and professional Me mas. M g ' s present coping

choices are dearfy identifiable as short-tenn tasks and activities: arrangements

for immediate and extended family, h v d p h . coverage for the parish

ministry in his absence. While his &ce of coping strategis for the

management of the long-tenn impact of thîs crisis are unknown at this point,

Pastor Craig demonstrates an ongoing mess of integrated qqwuisul. He

recognizes that he has not yet resolved the traumatic experiences of the

emergency he was recently involved in, nor the @or persona1 expiences that

event remmecteci for him. Gaig W e r recognizes that, in part. his abiiîty to

respond to this family crisis is king shaped by those lingering burdens. Findy,

Craig is acutely aware that of his two primary coping resoivces (namely, his

Christian faith and his M e ) , Grace's support is not avaihble to him in their

present situation, in the usual sehse of offerhg him strength, stabdity, reflection

and emoticmai refuge. At this point, Pastor Craig is functioning in simultaneous

procesres; m e y i n g the situation and his available resowces h m dual

petspeaives (integrated appraisal), and selecüng coping options that are (although

only short-terin) effective and congruent with his personal and professional

culture (integrated coping).

The tenth element, titled Ine@ctive/Inadequate Coping QO), oaupies a

minor position in the present model, simüar to that dacribed fur Preuims

Dysf.ndm1 Cq*ng. However, where the latter segment focuses on past

incidents or pattems of behaviour, the element titled itl~deqwte / I ~ ~ ~ u e Coping

accounts for choices and experiences of dysfunctional coping behaviour in the

immediate experience of the c0111passionate professional encountering

potenWy impairing conditions- While the critical procesees of integrated

uppraisaf and integnited cuping demand attention to both personal and

professional spheres of lik, there is no parantee that the individuai wiil rnake an

approPnate or helpful match between the Unmediate aisis and the coping

options available. In the event that the compassionate professional has not

attended to the development of a repertoire of proactive and personally

congruent resources, it is quite W y that coping choices wili be poorly made

(Wong, 1993), ocauring by defadt in the absence of a positive choice, or by

choosing a negative reaction which does not contain potenaal kefits.

The case of Richard, a student services cmnselîot Scpenencing

simultaneous conditions of b o u t and xcondav tmmat ic stress, clearly

identifies an instance of ineffective, and potentiaîiy damaging coping behaviours

that fit w i t h this segment. By his increasîng use of alcohol and self-imposed

isolation to manage his growing distress, Richard both obstructs his available

and proactive coping options, and increases the likelihood of developing an

enduring dysfunctional pattern. Katriana's story tefiects a similar default to

inegMiw coping in her binge activities of excessive spending. Udike Richard,

however, Katriona demonstrates an early recognition that this choice is

ineffective and potentially damaghg to her long-tenn interests. At this point,

Katriona moves out of an i n @ c h e / i d e p u t e cop~*ng process, and badc to the

tasks identified in the mdei as intepufad llpp~aisaf and integrated coping; Richard

demonstrates no such benefid insight

It shdd be mted at this point that another option &ts fot the

compassionate professional at risk - an option which teflects a coping

alternative that is, at the same time, both effective but imbaianced in tenns of the

personai and professional spheres. This altemative is observecl in the story of

Louisa, a chilàrens' mental health therapist, and her initial decision to leave the

profession entirely. When assessed h m a purely pragmatic position, the

individual% voluniary departure from the profession (whether pastoral or

therapeutic) may in fact, dfiaently deviate the risks, and contain the effects, of

both buniout and compassion fatigue. However, when asseased accordhg to

the m e n t moàel, the sarne decision reflects the i t t l l d e p q of this dioice when

compareci to a strategy of integnited coping. ResumabLy, leaving the profession

allows nei- the positive res01ution of redevelopment from a depleted

professional de, not the healthy integration (and probable healing) of the

person-as-professional. It is important to recognize that the intefpfetation of this

choice as an "effective but imbalanced" mode of coping applies only to those

instances in which the individual departs the profdon in the wake of

unresolved compassion stress and depleted/ incongruent resouzces. Where

career changes are made solely for reasons of life-stage dwelopments, health, or

prevailing market amditiom, such choices cwld easily refiect balanced, adequate

and positive coping.

Loss ta Groltoth

The fmal element contnbuüng to the wrent model's synthesis hames a

broad spectnun of potential outcomes for the ampssionate professional

challengecl by the uniqye stressors of non-volitional life disnipticm. It is a

spectrum well described as the individual's oppominity to either "rive, thrive, or

Mt survive". Smply labelled Loss to G m t h ( I I ) , this segment addresses issues

of threshold and stability whkh are crucial to the development of either

compassion fatigue, or compassion d e n c e . In the present model, loss to

grmuth repments both the distinct stage of decision/non-decision (with its

inevitable movement toward some form of tesoIution), and the threshold of a

larger life-context. It is the element of the mode1 where the cumulative effects of

all previous segments are moet dynamic*

If the compassionate pfessionai's background of trauma, recollection,

exposure, and prior ineffective coping outweigh resources Uiat are depleted or

inconpent, then the likelihood of compassion fatigue is extremely high. Such

an outcome is dearly a loss situation in its immediate context (e.g., loss of Me,

health, mental health, relatiomhips, occupation, stahis), and may, in fact, contain

the seeds of future and enduring impairment* The case of Richard contains

several indications that the W y outcome will be one of compassion fatigue and

sustained lm.

If, however, the individual rnanages to 'Wg on," in spite of the Çhaos

mought by combinations of b o u t , SE, criticai Me disniptiolis and other

elements, then it is W y that a survival mode has been achieved. The best

description of "survivai" as eXpenenced at fhis stage is the continuance of both

pasmal and professicmai functiom, but with a pfound depletion (and perhaps,

a WhLal absence) of mping resources. As a result, little tolerance remains for

additional complications, ambiguities, emqenaes, or exhausticm, leaving the

professional in a hi* vulnerable state. At kt, this phase in the spectnim of

loss to growth offers the individual a tenuous threshold, and a transitid state

m which it is impcmsible to remain for any extendeci period. Future encounters

with extiPme distress or mild but dvonic stress wiU inevitably destabilize this

middle "SUTVival" state, most likely toward the impairhg experience of

compassion fatigue and its attendant losses.

If, however/ the compassionate professionai fin& value, meaning, ot

purpose (Frankl, 1959,1%2; Nouwen, 1972,1979; Wong, 1991; Won& 1993;

Hicks, 1993; Figley, 1995; Wyatt-Brown, 1995) in the midst of the potentially

impairing experience, the Iikelihmod is great for re&g a state of compassion

tesilience. As noted earlier, recognition of the human capacity for d e n c e in

the face of a d v e t y is a subject consistent across religion, philosophy, fok-

wisdom, the arts and, lately, science. Katriona's story offers a simple illustration

of this " p w t h from loss" therne, wihressed in her decision that something

"useful" for o t k women ought to emerge h m her experience. Such a

conviction, although powerless to alter the amimstances of her present

condition, mobikes Katriona to activity that is beneficial on several levels.

Firstly, it asBists her with coping in the present moment (integrated copnig).

Secondy, it allows her to maintain a professional peftpective and identity in the

midst of enormous non-volitional personal disruption ( h t e p t e d ~ p p l a i s ~ l ) . A

third benefit is tealized in the mation of a future-focus towarci which Katriona

may order her resources and subsequent coping choices (proactive congrtient

resource repertoire). F M y , Katriona's focused activity strengthens her

inclination to pursue p w t h and pirpose, rather than becoming enveloped by

mental and spintual fatigue, or acœpting bare Survival as suffisent. Katriona's

story indicates a mow t o w d compassion resilience thn,ugh the influences of

an existentid coping orientation amsistent with her established values and

beliefs.

Summanr of the Mode2

The preceding chapters clearly document the dearth of resesvch and

theory regarding pmblems of dergy and counsellor impainnent speafically due

to combinations of si@cant, involuntary lik disruptions and the burdens of

their compassicmate vocations. This void may be attributed to severai causes.

Several researchers (Sherman dr Thelen, 1998; Sheffield, 1998; Baird, 1999)

comment on the relative recency of the counseiling profession's attention to

issues of impairment among its pracütioners: existing literature reflects this

attention as generally focused upon imphents due to addictions or power

differmtials, and appropriate interventions and coUegial responses. Similarly,

pastoral mearchers Fortune (1989)? Steinke (1989), McBumey (1986,1989) and

others represent a p w i n g movement in the professional ministry toward

respo~t~lily attendhg to impairment problems in the dergy experience. The

focus of this movement atso tends to be upon problems and interventions

relateci to substance use, sexual behaviours and other abuses of power.

Although writers of the psychoanalytic sdmols continue to generate anecdotal

and first-person accwnts of devastatïng events in the context of their therapeutic

effects, Figiey's (1995) development of a mode1 trachg the transmission of

secondary traumatic stress is the first theoretical acknowledgement (however

~sory) of the effects of persord iife disniptions in this sphere of professional

fwictioning. DiGiuiio's (1995) investigation of diüd welfare workers

a<penencÎng signi£icant pemmaî personal is a rare example of ment research

puisuuigUusrecognition.

Nowhere, howevet, is the a dear vision of the effecfs of specifidy non-

volitional Me disniptions - random, adverse, unavoidable, catastrophic events

- in the life of a compassicmate professional, when combining thejr influence

with the deleterious effects of a "drahing" professional Me. Further, when

assessed accordhg to the suggestions of recent work by Wong (1993) in the area

of congruent coping resources, the problem of non-volitionai professionai

impainnent naturaily raises cpestions of professional d e n c e - The present

modei, Non-Volitional Imwnnmt anà Resilimce in Compnssionate Proféssionals

(Figure 4), seeks to addresPl this void. This integration of existing models

achieves the extension and viable synthesis of both the profoumi professional

effects of personal disaster first intimateci in Figley's (1995) work on compassion

fatigue, and the value of rneaning-centreci, congruent coping propounded by

Wong's (1993) model.

The construction of this mode1 of m-ditional imwnnent out of s e v d

independent segments represents, at the same tirne, a series of dependent,

synchronous and m u W y inauential elements. As noted in the ptevious

disassion, the temporal pperties of the model are l e s rigid than a simple

"start-tefinish" progression, since (depending on the individual in question) the

development of either compassion fatigue or compassion resilience may indude

cyciic, altemating andlm simuitaneow pathways. There is, however, a general

fiow to the modei, illustrateci in F i p 4, which takes care to presenre the

integrity of the contributhg models (Wong, 1993, Figure 3; Figiey, 1995, Figures

1 k 2), while concentrathg upon the activities of Uiis unique combination.

S iar ly , certain ekments (e-g. culhual context, life disrupüons,

ineffective / inadequate coping) have acqukd slightly m m limited definitions in

the blendeci model than are found in the source md&. These narrower

definitions are employed for purposes of clarity, and to direct spea6c attention

to the experiences of counselling and pastoral pfessionals at risk

CONCLUSIONS, iMPUCAnONS AND APPLICATIONS

A BriefRePieto

The c d to care for others is not without a price. Professicmals who

engage in the compassionate vocations, induding counselling and pastoral amI

are espeaally susceptible to the emotional and psydiological costs attacheà to the

long-tenn witness of distress and d e r i n g as experienced by othe~s (Figley,

1995; Witmer dr Young. 19%; Emerson & Markos, 1996; MCBURWY~ 19û6;

Raybum, 1991; Sowa, May Q Niles, 1994). Neither are compassionate

professionais invulnaable to the occurrence of similar events and conditions in

their own lives. Signihcant personal crises are quite likely to be encountered

concurrent with the demands of their professional hctions: death and

bereavement? illness, broken telationships, violence, or amUnstances of disaster

may happen to any person, of any stahis, at any time. As demonstrated in the

literature conceming secondary traumatic stress, it is at the intersection of such

catastrophic personal crises? and the intense demanâs of the compessionate

profession that the practitioner is most at risk for expe&mcing the negative

efkts of depleted coping resoutces, exhlxted particulariy in the development of

compassion fatigue. One of the contributions of the synthesized mode1 is its

emphasis that the point of criticai convergenre between pfessionai burâens

and personal tragedy need not inevitab1y result in the lasses of compassion

fatigue? but can instead offer the individuai an opportunity for growth,

ultimately becoming a path ta compassion resilience.

Th- is nothing new in the recognition of this dual-directional

phenornenon. The language of folk-wisdom is strewn with fragments applicable

to the aitical threshold of human endurance: "the straw that breaks the camel's

back," "when the going gets tough, the tough get going," "benci, but never

break," "too little, too late," and more recently, "no pain. no gain." in a simple

and elquent intetpfetation of the philosopher Neitxhze's tirneles statement,iO

one n o v a t observes that "the world breaks evefyone, then some h m e

s b n g at the broken places" (Hemingway, ated in Hicks, 1995). Biblical wisdom

unicpeiy and consistenlly expresses the understanding that this universal

eXpenence may be embtaced as an opportunity to seek the presence of Gd, that

it is only in the W s t of human weakness and brokenness that the blessings of

Gd's grace and stcength can be most dedy reaiized (e.g., 2 Corinthians 12;

Hebravs 4.15; the Book of Job). In the context of the compassionate

professional's experience with si@cant lik disniptions and impaunients of

non-volitional origins, these traditional insights conkm the model's description

of movement toward either compassion fatigue or compassion resilience.

Prot,lems of profesional impairment created by incornpetence, substance

abuse, or o h responshiiity-bearing choices have been extensively identifieci

within the disciplines of medicine, nus@ and social work. The professiom of

counselling and pastoral ministry have been markedly slower to recognize and

address these same problems, although curent Iiterature reflects a positive trend

in that direction, Less weil acknowledged in any of these fields, however, are

impairment problems related to "unconttollable" sources such as general aging,

deteriorathg mental abüities, or circumstmces of extreme advemity.

Thete are multiple and compiicated issues sinmnuiding impaired or

1 O That Mich does not k l me, mkes me strongeï(cited in Fmnkl, 1962).

incompetent professional performance assoàated with advancing age, cognitive

or peftonality dis or der^, or other h i c d conditions (not related to an identifiable

addiction). The most obvious examples are witnessed in relation to the

involuntary temination of an affecteci individual's pmfessional activities, and the

related ethical challenges confronting informeci colleagues. Clearly, awareness

of these sensitive issues demanâs M e r exploration and undersbnding in the

distinct contexts of the professions involved. Demanhg both theoretid and

concrete investigations, research in the areas of medidy-, personality-, or

aging-based impairments should also attend to appmpriate methods of

intervention and support, and to the professionai's unique experience of the

affecting conditions. E q d y important, though iargely overlooked in theory

and research literature, are the issues of potentiai professional impairment

arising h m chronically adverse conditions, and kom profound a . unavoidable

disruptions in the peRonal life of the compassionate professional. The

integration and extension of Figley's (1995) notion of degree of life dimupüon,

and Wong's (1993) batment of congruent coping, into the framework Non-

Volitional lmwment a d Resilience in Compc~stiomte Projkssiott~k is an innovation

intendeci to focus attention upon, and rudimentarily address this void. Where

the suggested mode1 of impairment a . resilience among compassionate

professionals invites application auoss these and other situations, the narrow

definition of "non-volitional" adopted hem places the problems aeated by

aging, cognitive deterioration, or personality disordm outside the scope of the

present discussionl~

11 7 he mader intsrested in leaming more about problem of aging, pmonaîity dÎÎôereô, or cogniüvely impaireci compassionate prdessiortals shoulb consult S h m n (1996). Emeison and -05 (1996). Resrner (1992), Coster and Sch- (1997). and Sheffield (1998). and pursue s e d of the excellerit reler8ms contained in thcse sources-

combined efkcts. In the absence of an integrated vision of the PefSOn-as-

professional, the stability of "just swivuig" becornes a temporary state at best,

and one more than likely to serve only as a threshold toward further signihcant

1- in eventual compassion fatigue.

The fusion of progressive and pardel work by Wong (1993) and

Figley(1995) containeci in the structure of the mode1 b h - V o l i f i o ~ I Imwment mtd

Resilience in Comp~ssionate Profetioonals moves beyond the perspective of simple

professional &val. Considered in the context of Wong's themes of culture,

congruence and coping, Figley's conceni for the practitioner saturateci with the

trauma of others acquires an even sharper focus, examining the experience of

the carhg professional faced with extreme persona1 life dimptions of a non-

voütionai nature. The unique character of this harmonization finds its fullest

expression in the model's conduding segment, where, Muenceci by Wong's

emphasis on personal meaning, Figley's concept of the condition of 1- known

as compassion fatigue is extended to indude the potentially enrichhg experience

of compassion d e n c e .

Identif'vini~ Potentid Amlications and Challenms

The constnicüon of the plesent mode1 makes no claim to rephce or

supercede existing paradigms in the fields of stress and coping theoryf

professional development, or psychotraumatobgy. It is not a workbook plan

for the development of coping styles, nor an extensive kt of çelf-care strawes

for either the counselling or pastoral professional in distress. It is not a new

mode1 of resource-based coping. Neither is it an exploration of the role of

relational-, a--, ococpatidyyf or addicüoxwbased aises in the lives of

compassionate pfessionals, since ail of these are more than adequately

adckssed h u g h literahire and research in theV respective fiel&. Similarly, the

non-volitional moàel of compassion impairment and resilience makes no effort

to resolve the ongoing professional dialogue regarding the distinctions and

similanties between secondary tramatic stress and viarious traumatization. It

is not a new modeî of trauma-tesponse thmry. It is not an artifiaaiiy

"spiritualized" application of secular prinaples to the Christian professional's

experience; nor is it a completely developeâ integration between the counseuing

and pastorai vocations. Rather, this model se& to idenbfy a speciric important

area in the experience of the professional caregiver, one which has not been weil

conceptuaiized. At the same tirne? it seeks to establish a iikdy direction for

M e r investigation, both conceptuai and empincaî, in this domain.

Given this clear focus for the -nt model of compassion

fatigue/compassion resiliencer the possi'bilities for its application are broad.

Recent research findings demonstrate strong differences in emphasis between

practitioners and academics when considering issues of professicmai pfeparation

and subsequent weU-hcüoning among psychologists. Simiiarly,

denominational administrators' perceptions of pastoral fundionhg and the

support resomes available to clergy differ signifi~i~ntly fmm the perceptions of

the cl= themselves. Given these dispanties, it seems W y that desipers of

pastoral- and clinical-training programmes d d benefit from familiarity with

the propased model. The augmenteci modeYs foo i s upon both integrated

appraisai and intepted coping in the compassionate professicmai's eXpenence

suggests a nahial bridge between the differing perspeaives of the

admsiistrator/academic and the " r d life" practitioner.

Administrators and directors of counselling agenaes and mental health

clinics (whether community, campus or private), and persans in f o d positions

of church leadership would also do well to be aware of Uiis integrative model,

with its emphasis on the potential for growth as well as loss. This is equally tnie

for counding and pastoral pmfessionals who involve themselves in extended

work with trauma swvivors, and for those who respond to emergencyl trauma

events m e n t l y , or who hindion as primary responders in the intense phases

of the traumatic event. In these instances, an understanding of the loss to

growth spectrum following si@cant non-volitional life disruptions can be

usefui both for client care, coileague care, and for enhand seif-awareness of the

professional's own eXpenences.

Persans who provide the principal emotional supports for members of

the compassionate prokssiom (espeQally spouses, other f d y members, and

colleagues) muld also benefit greatly h m understanding the rnodel's contexhial

blending of personal and professional experience. This is partidarly tnie for

clergy families where, as dernonstrateci in earlier chapters, the lines between

work life and private life are frequently blurred by the demands of a lninistry

that m o t be confineci to office hours, and which &ts in the structure of the

unique cultural community surrounding Christian clergy.

The present model invites hvther research into the phenornena of

compassion fatîgue and compassion resilience, with vimially limitless

combinations of interest. Ernpirical investigations of secondary traurnatic stress,

coping resourres, sbbility thresholds, cultural influences, and dysfunctional

behavioural choices have weil-established histones, and continue to q a n d the

spedic and general knowledge bases of psych010gy. Using the context of the

aupented mdel's integrated peftpective, and speàficaily focusing on the

etkcts d distressing conditions created by non-volitional events, extensive

empirical exp10ratim of the issues pertaining to clergy anci counselling

pmfessionals could signüicantly enhance the direction of professional support

and development, both in these particuiar fields and in general. Additionally, the

present topic raises issues and questions eminently suited to the employment of

quantitative and qualitative research methods. inquiries into unique personal

eXpenences, the development and expression of personal meanin& and the

cMlenges of coping in the midst of distress offer perfect opporhinities for case

study and depth-interview reseaich W e the psychdytic schools have

generated a spate of first-person accounts moving in this direction, the

structured investigation (both quantitative and quaütative) of questions

surrounding non-voiitionai impairment and resilience among compassionate

pmfessionals is an m a clearly in need of advancement, and one which is primeci

for p w t h in the inunediate future.

F M y I the construction of the non-volitional impairment and resiiience

mode1 is most applicable to the direct experiences of the professiona.ls upon

whom it is focused. CouIlsellors and degy, pviding intimate and supportive

care to emotionally wounded people on a continuing basis, are themselves at

tremendous risk for distress when faced with a personal and uncantrollable

catastrophe in addition to the demnds of theV w& This is the heart of

understanding non-volitional impairment. Compassionate profesionals will

benefit from actpiring a dearer vision of the unicpe cultures of their professions,

the relatiomhips between personal and professionai distresses, the desirability of

developing a b d repettoire of feasiile and congruent coping tesomes, the

se& for personal meanin& and the spectnim of potential loss and purposefui

growth.

A Final Wwd

Thete is a price exacted in living out the vocational caii to care for others.

Compassionate professicmals kqyently pay that price in the coin of absorbed

trauma, private distresses, and ultimately, devastating personal and professional

impairmentS. The vision behind the present model is to assist pastors and

counsellors in developing a more complete understanding of the need to realize

th& personal and professional inkgration, and to prepare purpasefully for the

near- tuunbearable burdens created when their "mal Me'' colides with the

compassionate demands of wotk. To impart a similar vision of the potential for

enrichment and resilience beyond the losses of compassion fatigue is the

ultimate, extravagant, and sincere purpose of this harmonized model.

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Casr 1: Louisa. a Mmtal Heulth lkeram&

Louisa is a childrens' mental health therapist. She is a pvinciai

employee, w o r h g out of a community oface in a district with an urban and

rurai blend. Whiie the majority of Louiea's caseload are children who have

eXpenenceci m e form of semai abuse, she aiso sees children and families who

may be eXpenencing @lems unrelateci to sexual exlploitation. Lüce other

therapists across the provincep Louisa's office is s e v d y understaffed for the

popdation it m e s ; she is chronidy overbooked, works through her breaks?

and tiequently completes case notes and other paperwork on her own, unpaid

time.

Louisa loves ici&? and the creative things she's able to do to help them,

but she's been feeling less than enthused about this set- she has worked in for

so long. The pcditicized climate of the office and its pubk employer have a

grhding effect on Couisa and ha colleagues. In fact, she thinks some of thern

might have lost th& professional ideaüsa It's t h g to go into work, especially

in the days fdowing a fundingat announcement, or when the media focus on

a hi@-profile child-at-rik Louisa has, lately, found herseIf living for statutory

holidays. Ftequent and signincant staff dranges are becoming more of a

pmblem, too. Louisa sees many of her lcmg-time colleagws seeking transfers or

leaving the profession altogetherp and theK replacements - often only recently

trained - generally stay for only a short while. This instability is maLing it

for Loulsa to suetain reliable condting amtacts and at-work supports.

Louisa has both personal and professianal reasons for remainmg in her

job. She has invested s e v d yeam building her career and developing effective

methods to work with %et kids"; she likes the commUNty she iives in, and is

not willing to renew the fuiancial risks of starüng over; and she feeis a sense of

duty to the chiidren she m e s and those yet to corne..... "if not me, who?".

Louisa beiieves that wen a little bit of change d d help her pst this bumt out

feeling; pezhaps just one more permanent, expdenceci staffer, or a new

structure for flexible work hous. She hopes, but without much conviction.

Yesterday moining Louisa saw a new client family in an emqency

situation, a case that she kmws is going to be long and e m o t i d y costly to

c m . The children d v e d with theh mothei. Just two days ago, they

witnessed the violent death of th& father, as he tried to aid a woman who was

king assaulted. Her attackers turned their hiry upon him, kickhg him to death

in front of his family, then ran away as other witnesses called the police and

moved fmd to heip. The young famiiy had been out for a spedal night of

hamburgers and a movie; it h a p p d in the theatre parking lot

Reading through the !künd Senrices notes was hader than it usually is.

Louisa eXpenenced an ovewhelming pit-of-the-stomach feeling and found

herself battling sipificant shock symptoms. It took her several minutes to

compose heRelf before going intb the Quiet Room to be with this little family,

and hear their story.

Her su- later cunvinced her b book off the test of the day, as

Louisa seemed unwell following the session. Since then she has, in fact, been

experiencing buts of nausea, lœt concentration, confusion, a<treme jumpiness

and intntsve visual images. She feeis lüre she is king assauited aii ova again,

but she knows that it isn't really happening. niat was all over twelve years aga,

and she knows that she is d e at work, at hoaie. Really. But living through the

little farnily's story - and it is still unfo1ding for them - has taLen werything

out of her. Ifs "sent her right back there."

Louisa made a deasion k t night. She's going to quit her job.

This has been one of the longest weeks of Louisa's life. It's been fau days

since she decided to throw in the towel at the Ministry. So why is she bobking

clients into next month? Because her supervisot wouldn't accept her nesignaticm.

Because they talked it aii out Tuesday moniing, and Louisa stiU couidn't onvince

him why qui* was her best opnion. Because she feeis a little bit guilty over

the idea of abandoning ship in a crisis, when hurting kids don't have the same

choie. Because mat of the the, she beliwes in what she does. Because Dr.

Blacklock said he had some ideas about what's gohg on fm her right now, and

some plans about hav they can do some crisis management, and how to

support her thiough this. kause he made his own commitment to heip her

help this little famiiy. Because she thuught she was made of stronger stuff? and

hopes to be again.

So, she's staying. Tnie to his wod, Louisa's superpieor started with some

basics. Same of h m have nothing at all to do with clients. The fkst thmg was

to set a rekRal to set hes EAP in motion. He's not her therapist, ,Dr. Biacklock

said, but he's been around long enough to h w compassion fatigue when he

sees i t Louisa's always known about PTSD in her kids and familes, but she has

never thought of its d e in the context of her own helping pdession. She's SU

exhausteci, but tecogniPng just that mudi has producd an aiormous relief in

the iast couple of days.

As well, fhey've wmked out a Uree month half-the leave, with a plan to

teview it neai the end, in case Louisa needs an extension. With her resignation

letter back in hm own hand, Louisa realizes that she simp1y can't a f f d to quit

her job. She can't really afford an extended LOA, either. Twelve weelcs at half-

time soumieci wonderfd, but since she's never head of an anangement like

that, louisa wasn't convincd Pagonnel would ok it. Dr. Blacklock said that's his

pbtem, not hem, and besides ....... they'l be happy enough once the nwnbers

pmve m m favmable than another posting-search-6r-hire process. Anyway,

he'd rather help to hep a good therapist intact-

%, Couisa's scheduling into next month, spacing out her caseload, and

paesing on new intakes to support w o r h . She just might survive thtough all

ttnis.

Case 2. Cr& a Parjsh Pasta

Pastor Craig is in bis fourth year of arinistry with a small suburh parbh.

Before this, he spent six years as an assistant- and youth-pasta in a large

meûmpoiitan congregation. Craig began his W - t h e ministry fifteen years ago,

when he was d e d to serve a mdti-point d eh. Pastor Caig and Grace

have been marrieci far fourteen years and have three children, ages 13,lO and 6.

Grace carries out a lot of "unsung" ministry in the congregation, in addition to

c d worlr as a float nuise at the local hospital* The couple welcomes the extra

income her job provides, but between Caig's busy schedule and Grace's short

notice for shüts, they are often pnidied for family time, and regularly have to

juggle arrangements.

Although far h m all theh reiatives, Pastor Ciaig and Grace like the t o m

they are presently living in. Besides nndmg a 'hame" for themseives in the

chu& they have made fnends with s e v d families in th& neighbourhood, are

happy with the local sdtools, a d have their kids involveci in lots of community

and congegational activities. Craig and Graœ hope to be able to buy a home of

their own within the next year.

Like al l congregaticms, in spite of a grnuine de& to follow Quist, this

church has its problerrts. At the t h e of his arrivai, Pas- Craig found the parish

riwn with disagreements and Mties, both real and imagineci, so the major

portion of his enagies have been chcted t o w d couns&ng, building and

reconciiinp relationships. It has mpi& a huge motional investment fnnn

both Craig and Graœ, but in this f d year they are keling enamrageci by

iitüe s i p of pmgress.

Last week, at the monthly lunch meeting held between m e m b of the

community's ministerial, cme of Craig's colleagws sufkred a heart attack Craig

was diredly involvd as a h t responder? Ireeping CPR going with Fathet

PetireUi's Wp until the ambulance arriveci. AU the whiîe? mernories of that other

tirne he'd had b do the same thing - for his dad - kept flashing aaoss Craig's

minci.

He's been inQedl%ly tireci sine then. Grace ha9 been heipfd, but

everyone else seems to expect the same measure of Pasta Craig that he dways

gives. This morning when the phone rang More breakfast, he tned to just

ignore it. When he caught it on the fourth ring, it tmk a couple of minutes

before he ~alized it was his brother-in-law, ttelling him that Grace's dad died in

the night.

She's standing m the doaway now, asking Craig why he looks so ill.

Today feels a thousand years long. He's still not mdy over last we&s

crisis. Craig is tired of leaving phone messages? and thinking in details and

arrangementsI and then remembeMg why he's ha* to do it ail. S i this

moming's di fkm Dave, it kels like that all he's ôeen doing. That, and praying,

and wonrying about Graœ. She's doing ok, amsidering, but it is sort of hard to

tell with her. Eght now she's ok - the kids are with her, malring some cards

for th& Nanna. Craig'Ujoin themas sain as he finishes the notes for the

deaams.

After thqr heM one another thmu@ the absolute shock of Dave's news,

one of the fmt things Craig and Grace had to do was malce a tough deâsicm.

Therets no question they'd rather have the kids with them right now, but they

have to be realistic about time and money. Their firiances can't stretch to airfare

for ail five of them. And this ien't a holiday where they could camp the way

there a . badc again; it would mean mot& and restaurants for several days.

Besides, there isn't enough time, he doesnpt have enough energy to drive it, and

he wddn't want Grace to be stucL in that kind of limbo until they get to their

f d e s . He dK1 suggest to Gace that she should t& Poily with her, and he'd

stay home with the two y-er kids. He can't believe how muchbetter he

achially felt when she said no, she'd rather have him with her - what 14nd of a

dad is that?!? Then Dave called again. Gtace's mom thought she'd like to have

Craig take a part of the service.

So. Their night leaves b m m w rnoming at 10.00. The kids are taken

care of. As soon as the news started making its way through the church, Freddy

and Cade were there, annOUhQng thqr'd keep the kids at their place. What 's 3

more on top of the crew we've got? T h e 0 be ok ...out kids are already

drasgmS out the au-mattresses! We're so sorry about Grace's dad. Remember

we're keeping you ali in our praym." He's arrangecl with the deacons and

another local pastor to covet the church's needs for the week; they'U be badc by

nextsimday.

Craig's sure t h e ' s something else he's sripposed to arrange, but he can't

q i t e thmk of i t On top of eveqdùq else, he's banc-weary. It's been that way

since the day the emergency happened at the ci- lunch. He just hadn't

realized how mu& he's been relying on Cacm to be the strong one since then.

The problem is, he doesn't feel strong e w g h to camy hm through this.

Case 3: RidlRtd, a Shrderrt Scnrr9ces Counsellor

Richard has been on staff at the University Counselling Centre for six

years, having reœntly moved into a senior therapist position. Ifs a busy place ail

yen, servir\g bath students and the City where the University is located. Like

most 0th- branches of sWaG a d student-senrices? the Centre is having to do

more with lem; Richad is now respol\sible for 21 3 administration arsd a 31 5

caseîoad. He's done the math, and hows Uiat on paper ifs an equation for

ovedoad. But W s on paper. Ifs not going to be much of a problem for him in

real Me. Richard draws a lot of energy h m his contact with students, the

academic atmoephere, anà the physicai setting of the U. He fmds a hectic

schedule invigoraüng. He's in a g d marriage. He's fit, and considers himself

relativeiy young - he can SM see 30 - so Richard isn't really womed about the

extra load at wmk.

Today was the worst of bad days at work One of the students Richard

has ken wmking with for severai months, D., twk his own life during the

night. The constabies came to the Centre this moniing with the news, and the

questions. Ifs nut the first tirne Richard's had to ded with the after-effects of a

dient suicide, but thts one is the worst From the time of th& fUst session, D.

reaulnded him a lot of his own brother. They had gotten to h o w each other

reaUy wek and Richard has been seeing si- of impmvement and hope

beginning to grow in ttiis guy. He never expeaed at Uiis point that D. would do

the very same thhg Steve did. Once the investigatois Mt, Richard kept an

appointment with another fiagile dient, but Uien bailed out of a couple of

cornmittee meetings in order to 6ind =me tirne fw himself. He has spent the

aftemam second~essing his whole therapeutic history with D.

On the way home, Richard stoppeci into his &@bowhooci pub agaia

He needs something d i x ü n g . He knows a b Mt the greatest choiœ# but

itll do. Besides, it'll help him relax. H e l have one more. A k this one, he's

gohg to go home. For sure. Y œ œ œ œ ~ Y œ L I œ

Richard isn't sure who starteci last nighfs argument, but it wasn't pretty.

He was feeiing wrekhed by the t h e he got home. Trying to explain to Uargaret

what happened with D, he mentioned Steve. She said that was an excuse; it

happeneci so many y e m 40 , he should be mer it by now. She kept going on

about how she was womed because it was so late, and that he'd been drinlong

again, and that she was so tiied of this. He members thqr were yeliing at each

other. Richard feeis bad about dut, but at Least h doesn't have to feel guiity - nobody got hit. Wouldn't that have looked good on his iist of counseiling skilis.

The alarm didn't work this morning, making him too late for anything

but a drive-through coffee. He?l be sure to call Magaret from work, though,

when he gets some time today. He% incredi'bly tired this morning, but he'll pi&

up soon enough Being with people is always energidng.

Richard sorts Uirough the pile on his de&. Some policy changes he hasn't

hdd time to read y&; a blizzard of pink phone slips; diait files; a couple of

propoeals for the Centre, unfinished, but only a M e overâue; some riesouice

readhp. There's not much t h e to prep fot today's clients, but this couple are

practicaUydizect9ig UieP own sessions now, anyway. Hell be sure to have a few

resources ieady for them next week Then, there's still Do's 6îe to finish, and the

Student Services Director wants to meet with him sometime today. AU the

h o u d q h g s a that bis ta happen after somethjng like this. And the weekly

team meeüng is SU slated for this a&moon. Richard really meant to have that

new resounie binder on mens' issues finished for tday. He h o p the others

will understand and cut him some slak But at least the team meeüng will be a

bit of "ncmd", amsidering yestetday. ......... attet all, life goes on, ri@?

Richard is aware U t awful fit-of-theistamach feeling haen't left him since

yesterday moming. What he really wants nght now is to be anywhere but here.

Gulping a deep breath, Richard heads out to the dient waiang a .

L I I C I C I Y Y C Y Y I C I

Early evey moming, exœpt Friday, Richad iuns a qui& couple d mües.

On Fridays he does a long run after work. Ifs a Little titual he's carved out ovet

the y-, using the üme to do a mental review of his professionai weelr. then

dear it ali away and refcms on the weekend acfivities of his " o k life". Lately,

ifs been M e r to stick to his Friday nm, since work seerns to be spülllrs later

and later everyday. Today, Richard's got the the, but just doesn' t want to

bother. He's feeling wasted. The's got to be better ways of 6üüng that couple

of hows. Besides, it's been a lousy week since D!s death. ...... who wants to feplay

it? It's been so bad, he's even stivting to have nightimares about Steve ag&

Foiget the fitness plan. He'li sink into a good book, have a @et ber, and try to

get home about the same thne as Margaret does. C l œ ~ œ L I a œ - œ œ

Richard hasn't had a g d Iiight's sleep in the several weeks since D.'s

suicidee He can't relw; when he does anally fall asleep, it's only foi a liWe while,

since the nightmares are Whially nightly now. ThqN stop sooner or later, and

he'll get his balaire back AU it means right now is that he's had to malce a

couple of changes. For instance, as much as he misses it, the moniing nui is side-

tradd. But just for now. He needs to match that extra bit of sleep when he can.

Friday's nui is more of a hit-&mies thing, too, but at least he's doing fine

IUeeping up with the extra load at worlc And hds still "iight theren for his

clients, and working goad SM with them.

It has been a while since he met with any frimds or d e a g w s fa lunch - or even coffee. A couple of them have been in wondered when he's

phning to be "back to his old self," but Richard mally d0esn.t feel much like

socialiPng these days. And of came, Margaret doesn8t seem to miss a chance to

point out that he's dmpped into the pub a couple of times, erg0 that harpy-chant

"Richard, W s the third night this week Richard, you seem to be dnnking a lot

lately* Richard, is there something you want to tak about? Richard0 WWS

Wcmg with you?"

There's nothhg ~ o n g with him. He's a proiessional therapist; he'd

know if there was something going wrong, for God's sake* He's just doing what

he ne& to do, for himself, for a whüe. And thafs finding a way to telax. If

anybody really wants to ihpist he has a prob1em, they might want to amsider the

amditions he and bis team are eXpeaed to work under. Ot remember that he

deals with other peopW cappy shiff dl the tïme. Or ahwledge th& own

con~tio~lstothecirappystuffmhislik. Oramsiderthathe'stheonewho

found Steve. Even thinhg abait this stua is making Richard W, a d more

than a little angry. And deprmd. .........

After a i l these yem, is this ali there is?

Case 4: Klltdoll~ a Rivate Ractifjoner

It has long been Katricma's dteam to buüd a anuiselling practice focrrsed

on womens' issues, m the contact of a Christian ministry. In partnership with

her church and a talentecl deague, she has spent the last few years nurturing

Whole Heart Counselîing into a vibrant and effective professional entity. One

speciaîty that has emef8ed through Katriona's praCace is in the area of post-

abortion counselling. Her gif t for wmking with women and th& partnem in

this emotion-laden ciniuntance ia becomhg weil-knom Katriona is receiving

increasing numbers of &mals fran both pastoral and secuIar (often p m

abortion) sources.

Early in her career, Katnona committed herseIf b maintainhg a healthy

balance between her professicmal activities and her private Me. Although her

d - t o w n practice is a full and busy one, Katriona tries to pmted her persona1

and famiiy tirne away hom the anuieelling office. She imrolves herself in few

community activities, but chcmes thœe that are expressive and enrichhg she

has been involveci with amateur theatre, an arts guild, and the local photography

club. Katriana does what she can to stick to a healthy âiet, but in truth, chocolate

wins out a lot of the the. Mthough she hksn't the siightest interest in sports,

Katriona spends an hout working out in the pool wery moming, hating (but

surviving) each moment of it. Most importantly, Kaüiona attends to her

spintuai health and life For her, that means s t a . eomiected with the teaching,

miseion d fellowship of h &UT& and spendmg time in personal disciphes

of payer and study. Katriona also believes in, d e x e e s , a coxrunon serise

cOnnection between her Christian faith and prokssional ethics, reqnhhg that

each must be able to challenge and infam Uie 0 t . i ~~ .

Katriona M t been feeling quite as well as she wouM like for the last

little whiie, so she m w d her annd check-up ahead on her dendar. Th-

m e d to be an awful lot of tests and iab work this thne araind, but she diàn't

thinlr much of it. This moming she had a foliow-up appointment, just to "corne

in for a takm. She's sa not sure she hearà the doctor quite right.....everything

seems to be happening v q qUckiy.

Katriona doesn't lsnow why she's m g . After aii, she's seen lots of other

women thrnigh this. And, they say, the cure is getting dosez every day ..........

It's t a h Katriana the bettet part of the day to figure out what she needs

to do next. She's not convinceci it's a perfkt plan, but ifs wmkable right now.

She carRed through with her boom this alternoan - 2 individuai clients and

a small g m p - since she d M t thînk of a good enough teason, quickly

enough, to cancel. Hdes, she's never made a habit of bailllrg out on people at

the last moment, and doesn't intend to start now. Then again, she has a nagging

feeling that it might jtist have been her emotional autopilot, and not professicmai

mples, that kept her cm track at the office today. Katnona is acutely aware that

she wasn't reaiiy "with" her clients and coiieagws. She feeb exhausted at this

moment, but ifs hard to know if ifs an emotional reacticm to h a own stuff8 or

because she just didn't get a break between three back-bback appointmentsi.

After aU, Katriana m!mons8 r d life goes on. But she needs to think through

tomofiow and the mst of the week And everythhg. The pmblem is that, since

this momin%, everyUuns has been ail mashed tog* in her head, and thinlting

about one thing sets off another, and then she gets aU over the phce and

there. ........ it's happening again.

Katriona decides that one of the fiflt Uiuigs she neecls to do to deat the

confusio~istc,nndherspiritualbearings. ShererealizeçUiatsinceher

appointaient with the doctor this momins she has mt taLen any of her

customary stili moments of prayer about her dientsI her work with hem, or

wen her own needs. Drawing a deep breath, Katriona doses her eyes.

u œ œ - u œ œ œ œ - œ

Sinœ yesteiday, Katriona has been considering her worldoad thmugh the

next several weeks. Her k t impulse was to leave things just as they were, but a

gathering sense of reality has moved her to evaiuate it a little more dearly.

ClientsI gmups, woikshops, supervision and some coiîeague d t s have been

booked in advance, but with enmgh notice, there's always m m for adjushnent

Katriona decides that rescheduljng wything after the next two weeks should

count as reasonat,le notice. She also irreds to figue out what to dmp? anci what

to riearrange. Workshops pmbably arai't a big deal. She's most ccmcemed

about individual clients that she's seeing. some are doee to terminahg T a y ,

but so mwy 0th- are just begimnng theV work, or are in the middle of the

anihseIüng praiess. And what about her M c partner? And the church's

ministry goals? And how and when is she wen going to telï them about any of

this? Katriona doesn't want to just dump everythins and werybodyI but she's

afraid she won't be all that &le for the next little while.

After juggbg and -*&hg sevacal schemes, Katriona wondm if she's

maybe starüng at the wrong end of thinp. Maybe this isn't something she can

figure out on paper. Maybe this isn't something she can figure out done.......

Katriona ltnows she nieeds to be more than a little carefd with her

finances nght now, but that hawi't prevented her fnmi some *or spending in

the last ample of weeks. This moming it ocrurred to her that this is not stuff

she'd normally consider buying. None of it has the power to "W what she's

going through right now8 either. Katriona is stniggüng not to beat herseif up

over this, but spree shopping is not high on her kt of poeitive cophg choices.

Now that she's awme of what she's been doing, it!s t h e to thjnk thrr,ugh how

this e t look if it were a problem for a client8 and how she'd ûy to shape some

of her comme- to worbng on it. ~ œ a œ u # œ C I I ) œ

Ifs been more than a month sirace Katriona got the news about her

health; there's been a lot packed into that time. Her schedule has changed

completdy, not once, but several times. Some of the adjwtments were

purpoeeful, espegally the @&Onai ahes. Some of the changes have been

dictated by k new regimen of hedth-care appointments and therapies. And,

Katriona realizes, some Oiings have changed just because she isn't her own self

at the moment, W s even talring a break h m some of her creative p u b - that sort of fun shiff d d s energy she simply hasn't got right now. She's

pmised~iMIbeorreofUiefiistthingsshetedaimswhendthisisdone

with.

Katriona has also made some deQSim a h t who she is inviting to know

what is gohg on with her health, Of course, her family is a tremendous source

of support, but then, she's always been able to fount cm that niey're a dose

bunch Her partner in 'Whole Heart has been amazhg, too. Every now and thai

KatnoM worries that she's dumpeâ too much of the pracafe - she's not seeing

any clients8 and only spends about 8 hoitrs a weeic working on resourre

materiiils, or doing other odds and ends - but the two of them worked out this

p h together, and and counselling parûm assures her ifs more than ok that this

is what Katriona needs to do.

Kaüiana strusgied with what, and how much, to teli her clients about

whafs going cm for her. On the one hand, when chsasmg referrals or

terminations with her clients, disclosing taa much d d be distresshg for them

and not accompiish an- helphiL Besides, her privacy is important to k.

At the same tirne, she strongly believes that her faith and pf&sion demand

authenticity in her d e as a therapist. As well, Katriona lives in a small tom;

word gets arounâ, and people spedate on what Uiqr do not know. She finally

settled for le- her clients know that some health hues are requiring her to

talie a bmak form wark right MM, and le& it at that, Katriona's not positive it

was tkw best approach, but at least it wasn't damaging. ThinMg almg the same

hes, she chose to tell same of her dose aiends from the chu& what is

happening fw her, but from the rest of the mqpegation, Katriona has shply

askeù to be upheld in general prayer. Her M y and pastor support this

decision. çhe might change her mmd a little later, but not just yet

v c I I L . C I œ m - . L . L I

After a couple of weeks of feeling like she was just sitting around,

Katriona has decided she ne& to put some of this t h e away b m work to

bette use, so she's doing some tesearch on her illness. Not just magazine-of-

the-week stuffO but real diggiq - the kind she had to do in grad school. She's

nnally fi@ out which sorts of days are more productive foc W. T m W

days are the best for going aftez the material; 'tired" days are good for reading;

'nausean days am p t t y much a write-off, but they don't last forever. Katriona

came up with her plan one day while trying to think of h d as a client After

ail, her pfofessional penpective helped curb that spending riot, and she bught to

be able to pctice what she pfeaches.

The point of the se& isn't so much for her own information, dthough in

the initial days of h a diagnœis and decision-making, s k had to be quickîy and

thoroughly informecl. Ifs mare of an effort to pull toge- stuff that might be

useful for other women. Katnona found that the material her dators were

pvidhg her with was either too clinid, or too benign. (She loves that pun! At

least her sense of humout is etiU intact!!) At that time, she &y w d d have

welcorned the cluiicai fa&, qmken by a real person..... mt part of an ad by a

phannaceutid c ( 5 ~ t i o n , or Wtitten by some hennit pathologist in a dusty

texttiook It occurred to her that since she's spent the k t kw years putting

toge- usable w01:kshcp and mouras on othei tough issues0 she ought to be

able to do it on this, tao. The reseprdi isn't rnming at a fast paœ, and it doesn't

maice being si& any easier, but Katriona's fOund it does give her just a bit of

ccmttol over the âisease, instead of ahvays the other way around.