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The Warrior Therapist: Building Resilience Against
Compassion Fatigue and Burnout - a training
for staff and supervisors
Matthew Lindberg, MA, LPCCJeremiah Schimp, PhD, CPRP
MACMHP Winter Supervision Series December 8, 2015
INTRODUCTIONS
Matt and Jeremiah introductions Introducing each other:
What is your current role and position? What made you decide to attend this training? What do you want to get out of this training?
LEARNING OBJECTIVES
By the end of this session, participants will be better able to: Define compassion fatigue and burnout Identify signs, symptoms, and personal
contributing factors Understand the stages of compassion fatigue and
burnout Identify compassion fatigue and burnout in
themselves and others Learn and implement best practices for prevention
and mitigation of compassion fatigue and burnout Understand and begin to build resilience against
compassion fatigue and burnout in themselves and their staff
COMPASSION FATIGUE
“A state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper”.
Figley (2002)
COMPASSION FATIGUE
“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”
Figley (2002)
WHEN THE TOOL (YOU) STARTS TO WEAR OUT
BURNOUT
A employment-related syndrome that “represents an erosion in values, dignity, spirit, and will – an erosion of the human soul” (Maslach & Leiter, 1997, p. 17).
Maslach describes the construct as a “psychological syndrome that involves a prolonged response to stressors in the workplace” (Maslach, 2003, p. 189).
RESEARCH ON COMPASSION FATIGUE AND BURNOUT
-Rates of burnout in social workers and mental health workers is hard to measure-Younger workers exhibit more compassion fatigue and burnout (Lim et al., 2010)
-Social workers and psychiatrists are found to have higher levels of compassion fatigue (Rossi et al., 2012)
-Acknowledging compassion fatigue is helpful in coping with it (Newell & MacNeil, 2010)
-The attribute of hardiness may be a preventative factor for burnout in mental health workers (Schimp, 2015)
HOW COMPASSION FATIGUE IS DIFFERENT THAN BURNOUT
Burn out is a state of physical, mental and emotional exhaustion caused by long term involvement in demanding circumstances (Maslach & Leiter, 2008)
Burnout can involve a physical component
Burn out is a process, not a condition
Compassion fatigue is easier to recover from than burnout
Mostly affects those providing direct care
HOW COMPASSION FATIGUE AND BURNOUT ARE SIMILAR
Emotional exhaustion Reduced sense of personal
accomplishment or meaning in work
Mental exhaustion Decreased interactions with others
(isolation) Depersonalization (symptoms
disconnected from real causes) Physical exhaustion
COMPASSION FATIGUE
VULNERABILITY TO COMPASSION FATIGUE
Exposure - daily barrage of traumatic material (i.e. therapy, assessments)
Empathy - the greater your empathy the more effective the relationship and the greater the risk for Compassion Fatigue
Emotional state - current life stressors, relationship issues
Limited stress management skills - lack of outlets, hobbies, interests
Poor self care - poor nutrition, lack of exercise
Poor support - lack of connection with family and friends
WHO IS AFFECTED BY COMPASSION FATIGUE
Anyone who provides a service or listens to another person.Including, but not limited to:•therapists•social workers•physicians•nurses•counselors•nursing home employees•case managers•police officers
RECOGNIZE AND ACCEPT VICARIOUS TRAUMA (NOT NECESSARILY COMPASSION FATIGUE)
Occupational hazard in mental health Normal response to trauma and
relational work Just is/normalizing/being aware
Boscarino, Adams, & Figley (2010)
DO YOU KNOW OF SOMEONE AFFECTED BY COMPASSION FATIGUE? HAVE YOU BEEN
AFFECTED BY COMPASSION FATIGUE?
MYTHS RELATED TO CARING I can “fix” the situation I am a savior I am responsible for my client’s success or
failure The recipient will appreciate everything I do
for them I will have enough resources (time, money,
material, supervision, skills and training) to fix things
I can be absent from relationships and responsibilities because I am doing compassionate work
I can do this work without help If I’m trained enough, I can deal with the stress
of working with suffering people
RECOGNIZING THE SYMPTOMS OF COMPASSION
FATIGUE
SYMPTOMS OF COMPASSION FATIGUE (INTRUSIVE)
Intrusive thoughts of clients and their problems
Intrusive images of trauma described to you Taking work home with you Unhealthy or compulsive desire to help
certain recipients Work concerns take over your personal time
Florida Center for Public Health Preparedness (2004)
SYMPTOMS OF COMPASSION FATIGUE (DEPRESSIVE OR AVOIDANCE) Anhedonia Avoiding recipients and their concerns Less self-care activities (i.e. stop working
out) Loss of energy/development of fatigue Loss of hope Sense of dread when working with certain
clients Less feelings of competence Isolation from others Self-medication/addiction
Florida Center for Public Health Preparedness (2004)
SYMPTOMS OF COMPASSION FATIGUE (AROUSAL)
Anxiety Increased startle response Impulsivity Frustration Anger Sleep problems Eating more or less Concentration problems
Florida Center for Public Health Preparedness (2004)
SYMPTOMS OF COMPASSION FATIGUE (PHYSICAL)
Headaches GI symptoms Sleep problems Increased illness Fatigue Appetite disturbances
SYMPTOMS OF COMPASSION FATIGUE (PERSONAL)
Disturbances in perception Decrease in subjective sense of safety Self-isolation Difficulty separating work life from
personal life Diminished functioning in non-
professional circumstances Increases in ineffective or self-
destructive self-soothing behaviors
SYMPTOMS OF COMPASSION FATIGUE (WORK)
Avoidance of certain patients / clientsHypervigilant response to certain casesDiminished sense of purpose / enjoymentFeelings of therapeutic ineffectiveness
SYMPTOMS OF COMPASSION FATIGUE (SPIRITUAL OR METAPHYSICAL)
Questioning the meaning of life Questioning your prior religious beliefs Anger at God or higher power Increased skepticism Loss of hope or optimism
RISKS OF COMPASSION FATIGUE (AND BURNOUT) IN YOUR WORKFORCE
Sub-standard or low quality work Less effective client care Poor morale in the workplace Low job satisfaction Absenteeism Less client change
Mathieu (2007)
EXAMPLES OF COMPASSION FATIGUE • Kayla has been working with Mary, a
therapy client, for a little over a year. Mary struggles with depression, suicidal ideation, and has had several attempts. Mary also is the victim of domestic violence by her partner Tom, which she often details for Kayla in her sessions. Kayla is a compassionate therapist and wants to see Mary get better. Kayla has been struggling with thinking about Mary while not in the office, finds herself dreading Mary’s sessions, feeling less effective with her other clients, and wondering if she is a good therapist. Kayla’s boyfriend and mother are concerned that she does not have the same spark they are used to. Kayla has not seen her friends for a few weeks.
CONTRIBUTING FACTORS
What factors may have contributed to Kayla experiencing compassion fatigue?
What are some of her symptoms?
EXAMPLES OF COMPASSION FATIGUE
Richard is a dedicated in-home mental health practitioner. He is working with multiple clients who are struggling with suicidal ideation. Richard met with one client who was recently released from the hospital after an overdose and another client who cut her wrists and needed stitches. Richard found the last client at her home right after the suicide attempt and called 911. Richard has been going through relationship problems with his wife. He has stopped working out, which he usually enjoys. Richard is thinking his job may not be worth the stress, people just don’t seem to be getting better.
CONTRIBUTING FACTORS
What factors may have contributed to Richard experiencing compassion fatigue?
What are some of his symptoms?
RECOGNIZING THE STAGES OF COMPASSION FATIGUE
AMBITIOUS PHASE
Motivated by idealism Problem solver Making a difference Goes the “extra mile” High level of enthusiasm Actively engaged with clients Helps with extra tasks without being
asked
IRRITABILITY PHASE
Begin to avoid contact with recipients
Low view co-workers and recipients
Less socializing with co-workers and friends
Denigration of recipients Humor that is inappropriate Increased oversights,
mistakes and lapses of concentration
WITHDRAWAL PHASE
Becomes defensive Enthusiasm turns sour Recipients become irritants, instead of
persons Loss of hope for recipients Increased complaint about work and our
personal life Increased fatigue Don’t want to talk about our work Neglect family, clients, coworkers and
ourselves
ZOMBIE PHASE
We begin to hate people…any/all people Views others as incompetent or ignorant Dislike of recipients Less patience with co-workers and
recipients Less involvement in enjoyable activities Our hopelessness turns to rage
Florida Center for Public Health Preparedness (2004)
OVERWHELMED PHASE
Overwhelmed Somatic Illness Leaves the job or field
BURNOUT
BURNOUT AND BEING A SUPERVISOR
Burnout is based in part on the work environment, culture, function of the job, workload, buffering administrative “crap” for staff, turnover, scheduling, payroll, performance issues, communication expectations, lack of resources, staffing shortages, and on and on….
Meeting needs of staff individually and collectively
Balancing compassion for staff and being an administrator
Intensity differs by types of program… Type of staff, manager, supervisor…
Remember that your younger staff are more vulnerable
RECOGNIZING THE STAGES OF BURNOUT
Stage 1. Stress Arousal
Stage 2 . Energy Conservation
Stage 3. Exhaustion
STRESS AROUSAL
Persistent irritability Persistent anxiety Periods of high blood pressure Insomnia Forgetfulness Heart palpitations Unusual heart rhythms (skipped beats) Inability to concentrate Headaches
ENERGY CONSERVATION
Lateness for work Procrastination Persistent tiredness in the mornings Turning work in late Social withdrawal (from friends and/or family) Cynical attitudes Resentfulness Increased coffee/tea/cola consumption Increased alcohol consumption Apathy
EXHAUSTION
Chronic sadness or depression Chronic mental fatigue Chronic physical fatigue Chronic headaches The desire to "drop out" of society The desire to move away from friends, work,
and perhaps even family
BURNOUT IS:
Emotional Exhaustion
Depersonalization
Decreased Personal Accomplishment
EMOTIONAL EXHAUSTION
Feeling no longer able to meet psychological demands of the job or clients and feeling overextended emotionally by one’s work (Maslach, 1982; Maslach & Jackson, 1981).
DEPERSONALIZATION
Depersonalization is defined as viewing clients as less than human or in other negative, callous ways (Leiter & Maslach, 1988).
DECREASED PERSONAL ACCOMPLISHMENT
When staff feel poorly about their work quality and vocational accomplishments with a decreased belief in one’s personal accomplishments which can lead to low level of confidence in one’s ability to help others (Leiter & Maslach, 1988).
HEALING FROM COMPASSION FATIGUE
AND PREVENTING BURNOUT
WHAT ARE THE TOOLS YOU USE TO HANDLE STRESS IN YOUR
LIFE?
LIMIT EXPOSURE
Limit exposure to trauma material when possible
Limiting exposure during clinical intakes/assessments by focusing on other areas if possible
Don’t open up things you can’t close
SET LIMITS
Keep good boundaries with clients Do not mistake client’s needs for
mandates Watch number of work hours Take days off when needed, Encourage staff to take time off Seek help from co-workers or
supervisor
MAINTAIN PROFESSIONAL CONNECTION
Encourage teamwork Professional Education (CEUs) Support Groups Supervision and Consultation Working as a team/supporting each
other Consultation after supervision is over Getting to know others in the same line
of work Send staff to trainings for enrichment
CREATE BALANCE
Engage in non-clinical work at times (both at work and home)
Vary case load with different recipients, if possible
Furnishing workspace with personal objects
Make time between meetings: breathing, stretching, etc.
DISCONNECT AND UNPLUG
Don’t check work e-mail when not at work (or limit this)
Maintain a separate cell phone for work that you can turn off when not working
Depending on your job or role set clear guidelines of when you check and respond to messages
Screen your calls Communicate face-to-face when
possible Encourage staff to set their own
boundaries around technology
EFFECTIVELY MANAGING TIME
Limiting time with clients Knowing your time limits Making time for documentation Time for yourself between client
meetings/visits Teach your staff time management
skills
SEEK PERSONAL RENEWAL
Remember to find meaning in your work
Identify and celebrate successes with recipients
Renew hope in yourself and recipients
Maintain focus on larger purpose of the work you and your staff do
BREATHING AND YOGA POSTURES AT WORK
Breathing exercises Mindfulness Yoga postures
WELLNESS PLANNING
Personal psychotherapy, if needed Develop a personal self-care plan Manage physical health Seek out services that nurture your
physical wellness (YMCA, yoga, massage)
Use PTO Help staff with compassion fatigue
plan
MAKE CHANGES…
Different role at agency “Reinvent” your career What will challenge your staff Look at what your gifts are….
METHODOLOGY TO REDUCE THE RISK OF COMPASSION FATIGUE
Use of Motivational Interviewing to combat risk of Compassion
Fatigue
THE “SPIRIT” OF MOTIVATIONAL INTERVIEWING
Partnership Evocation Acceptance Compassion
HIGH SPIRIT SUPPORT
Accept that the client may not choose to change
Are invested in behavior change but don’t push it, in order to maintain therapeutic alliance
Reinforce that ultimately any behavior change is within the realm of the client
Elicits the client’s ideas about change
LOW SPIRIT SUPPORT
Counselors who struggle with clients choosing not the change
May demonstrate urgency in the session (example: death, jail or institutions)
Confronts clients Only counselor’s point of view is
“right” Rigid in their ideas and plans Try to persuade the client to change
“Righting Reflex in Action”
DANCING OR WRESTLING?
Roadblocks-Giving advice, making suggestions, or providing solutions
-Disagreeing, judging, criticizing, or blaming
Traps-Question-answer
trap-Expert trap-Confrontation-
denial trap
BUILDING RESILIENCE AGAINST COMPASSION FATIGUE AND BURNOUT
WHAT IS A RESILIENCE OR HARDINESS?
Hardy individuals actively engage in their pursuits and encounters, have a belief in their influence over situations versus feeling powerless, and have an understanding that change is inevitable and part of growth.
Commitment Control Challenge
(Kobasa, 1979)
HARDINESS
A theory espousing that there are reasons that some people are negatively impacted by stress and others are not (Kobasa, 1979).
Hardiness includes three personality components: commitment, control, and challenge. Commitment is the characteristic of being actively engaged in their pursuits and encounters. Control is a belief that one has influence over situations versus feeling powerless. Challenge is understanding that change is inevitable and part of growth (Kobasa, Maddi, & Kahn, 1982).
BUILDING RESILIENCE
“Building resilience does not happen by chance , but instead is based on active practice of decisions that lead to wellness and health. Many believe that the key to prevention of compassion fatigue is discovery and reinforcement of “compassion satisfaction,” those activities that yield a sense of satisfaction from working with clients” (Sadler-Gerhardt & Stevenson, 2011)
CHARACTERISTICS OF A RESILIENT STAFF OR SUPERVISOR Optimistic Open to change Belief that clients can recover Able to separate and contain client
distress Use social support networks Able to acknowledge limitations Recognition of skills and abilities of self
and staff Recognizes client autonomy and
responsibilities
HOW RESILIENCE IS FOSTERED
Through self-care and attention to your needs
Knowing your limits Changing your thinking Fostering Compassion Satisfaction Resilience is built and developed over
time
BUILDING YOUR RESILIENCE…..
Self-reflection Self-awareness Making small changes to care for
yourself
Maddi (2006); Hall (2012)
COMPASSION SATISFACTION
COMPASSION SATISFACTION
The opposite of compassion fatigue The good the you derive from helping or
caring for others The satisfaction may come from work
environment, the work itself, co-workers, self-efficacy, teamwork
Stamm (2009)
COMPASSION SATISFACTION QUESTIONS TO ASK YOUR STAFF
What do you like about your job? What satisfaction do you receive from
helping others? What do you like about caring for people? Why did you go into this field? What keeps you going?
COMBATTING BURNOUT AS A SUPERVISOR; QUESTIONS TO ASK YOURSELF
What keeps you going? What challenges you? What do you like your job? What do you like about being a supervisor or
manager? Why are you doing this work? What are you
getting out of it?
COMPASSION SATISFACTION
“One of the weapons we have against compassion fatigue is the satisfaction we get from our work” unknown author
ACTION PLAN FOR FIGHTING COMPASSION FATIGUE AND BUILDING
RESILIENCE AGAINST BURNOUT
HOW RESILIENT ARE YOU?
Do you keep a positive attitude during difficult situations?
Do you have skills to help you relax and manage stress?
Do you have a network of people who offer you support?
Do you take good care of yourself? Do you keep your eyes on the big picture
even in challenging situations?
RESILIENCY PLANo Individually• What changes will you make?• What does compassion satisfaction
mean to you?o Organizationally• What will you bring back to your
organization and staff?o Supervision• How will you provide supervision with
the information you obtained?
PARTING THOUGHTS TO SHARE WITH YOUR STAFF (AND REMEMBER YOURSELF)
o You’re not a Super Heroo The need in the mental health field will always
be greater than the resources availableo The suffering of your recipients in not yourso Look at how you measure “success” for
yourself, recipients, and your staffo Remember to care for yourself, you are the
instrument to help otherso Value small changes in recipientso Don’t take your clients home with you
“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” -Dr. Seuss, The Lorax
“If your compassion does not include yourself, it is incomplete.”
-Buddha
Thank you and be well!