TEND Associate Rebecca Brown on Workplace Compassion Fatigue

 

Rebecca Brown has a Master’s Degree in Social work and her career has spanned 28 years including medical social work, child welfare and domestic violence. For the majority of her career Rebecca was a Child Protection Team Supervisor at the Children’s Aid Society and was a founding member of the Critical Incident Debriefing Team for CAS staff following traumatic work events. She was a provincial trainer for the Ontario Association of Children’s Aid Societies and taught the curriculum on Wellness and Self Care. Rebecca has recently been appointed as an Adjunct Assistant Professor in the Department of Family Medicine, Schulich School of Medicine, Western University.

Rebecca now has a particular interest in Lifestyle Medicine and incorporates this into her practice of Wellness Coaching. Rebecca has been working with Francoise Mathieu and delivering workshops and seminars on the topics of Vicarious Trauma and Compassion Fatigue to helping professionals in a variety of social settings to balance the impact of the “cost of caring” for those in need.

Warning signs of Vicarious Trauma/Secondary Traumatic Stress and Compassion Fatigue

 

 Adapted from “The Compassion Fatigue Workbook

If you would like more resources after reading this article, please have a look at our online training resources and books.

We also have a more detailed example of Signs and Symptoms here.

Learning to recognise one’s own warning signs of compassion fatigue (CF) and vicarious/secondary trauma (VT/STS) serves a two-fold purpose:

First, it can serve as an important check-in process for someone who has been feeling unhappy and dissatisfied, but did not have the words to explain what was happening to them. Secondly, developing a warning system allows you to track your levels of emotional and physical depletion. It also offers you tools and strategies that you can implement right away.

Let me give you an example of what a warning system may look like:

Say, for example, that you were to learn to identify your CF/STS symptoms on a scale of 1 to 10 (10 being the worst you have ever felt about your work/compassion/energy, and 1 being the best that you have ever felt).

Then, you learn to identify what an 8 or a 9 looks like for you i.e. “when I’m getting up to an 8, I notice it because I don’t return phone calls, think about calling in sick a lot and can’t watch any violence on TV” or “I know that I’m moving towards a 7 when I turn down my best friend’s invitation to go out for dinner because I’m too drained to talk to someone else, and when I stop exercising.”

Being able to recognize that your level of CF/STS is creeping up to the red zone is the most effective way to implement strategies immediately before things get worse.

But look back to what also emerges in this process: you are starting to identify the solutions to your depletion.

If I know that I am getting close to an 8, I may not take on new clients with a trauma history, I may take a day off a week, or I may return to see my own therapist.

In order for you to develop your warning scale, you need to develop an understanding and an increased awareness of your own symptoms of compassion fatigue and vicarious trauma/STS.

For a more complete list of Warning Signs, have a look at the Compassion Fatigue Workbook or Compassion Fatigue 101 Course.

In their book Transforming the Pain, Saakvitne and Pearlman (1996) have suggested that we look at symptoms on three levels: physical, behavioural and psychological/emotional. As you will see, there is often overlap between these categories.

Please take a look at the list below and notice which ones are your most frequent warning signs:

Physical Warning Signs (More detail available in extra information post)

  • Exhaustion
  • Insomnia
  • Headaches
  • Increased susceptibility to illness
  • Sore back and neck
  • Irritable bowel, GI distress
  • Rashes, breakouts
  • Grinding your teeth at night
  • Heart palpitations
  • Hypochondria

Behavioural Signs (More detail available in extra information post)

            Increased use of alcohol and drugs

  • Anger and Irritability at home and/or at work
  • Avoidance of clients/patients
  • Watching excessive amounts of TV/Netflix at night
  • Consuming high trauma media as entertainment
  • Not returning phone calls at work and/or at home
  • Avoiding colleagues and staff gatherings
  • Avoiding social events
  • Impaired ability to make decisions
  • Feeling helpless when hearing a difficult client story
  • Impostor syndrome – feeling unskilled in your job
  • Problems in personal relationships
  • Difficulty with sex and intimacy due to trauma exposure at work
  • Thinking about quitting your job (not always a bad idea by the way!)
  • Compromised care for clients/patients
  • Engaging in frequent negative gossip/venting at work
  • Impaired appetite or binge eating

Emotional/Psychological Signs (More detail available in extra information post)

  • Emotional exhaustion
    Negative self-image
    Depression
  • Increased anxiety
    •Difficulty sleeping
  • Impaired appetite or binge eating
  • Feelings of hopelessness
  • Guilt
  • Suicidal thoughts*
  • Reduced ability to feel sympathy and empathy towards clients or family/friends
    •Cynicism at work
  • Anger at work
    •Resentment of demands being put on you at work and/or at home
    •Dread of working with certain clients/patients/certain case files
    •Diminished sense of enjoyment/career(i.e., low compassion satisfaction)
  • Depersonalization – spacing out during work or the drive home
  • Disruption of world view/heightened anxiety or irrational fears
    •Intrusive imagery (You can read an excellent description of this in Eric Gentry’s Crucible of Transformation article).
  • Hypersensitivity to emotionally charged stimuli
    Insensitivity to emotional material/numbing
    Difficulty separating personal and professional lives
    Failure to nurture and develop non-work related aspects of life

Take Stock:

Once you have read through and circled your most frequent warning signs, try and identify your top three most frequent warning signs. I call them the “big three”. Are they all physical, emotional or behavioural or do you see a mixture of signs from each category? Would you say that you are currently in the Green (healthy), Yellow (warning sign) or Red zone with your overall functioning?

Now, ask a loved one or close colleague to share with you what they think your “Big Three” warning signs are, at home and at work.

Next Steps:  

Each warning sign has specific tools that can help reduce your levels of stress. For example, if you are experiencing a lot of secondary exposure-related symptoms, you may wish to examine your caseload, the availability of debriefing and grounding strategies and you may need to assess the level of extraneous trauma images and stories that you are exposing yourself to in your personal life. If you have a lot of emotional symptoms, you may want to consider a consultation with a well-trained mental health professional who is familiar with vicarious trauma and the nature of the work that you do.

In our post on Tools and Resources (link here) we will provide some more suggestions.

*Suicidal or hopeless thoughts? Get Help Now Please remember that no matter how stressful/traumatic our work is, it is not a normal consequence of VT/STS to experience suicidal thoughts or prolonged bouts of depression or hopelessness. Please seek help as soon as you notice these symptoms in yourself. If you are worried about confidentiality, or unsure where to turn, please consult online sources of support. There are urgent suicide support hotlines available 24/7 which you can find with a click of the web. Don’t suffer alone. Get help. You deserve it and so do the people who love you.

 

Sources:

Figley, C.R. (Ed). (1995) Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Figley, C.R. (Ed.). (2002) Treating Compassion Fatigue, New York: Brunner/Routledge.

Gentry, E. J., (2002) Compassion Fatigue: A Crucible of Transformation in Journal of Trauma Practice, Vol 1. No. 3/4. pp.37-61.

Killian, K. (2008). Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self care in clinicians working with trauma survivors in Traumatology, (14, 2) 32-44.

Mathieu, F (2012) The Compassion Fatigue Workbook – New Revised and Expanded Edition

Van Dernoot Lipsky, L. (2009) Trauma Stewardship: A guide to caring for self while caring for others. BK Publishers.

Saakvitne, K.W.; Pearlman, L. A., & the Staff of the Traumatic Stress Institute (1996): Transforming the pain: A workbook on vicarious traumatization. New York: W.W. Norton.

 

© Françoise Mathieu 2017

 

Tools to Reduce Vicarious Trauma/ Secondary Trauma and Compassion Fatigue

If you would like more resources after reading this article, please have a look at our online training resources and books.

In a previous post (links here) we discussed some of the warning signs of VT/STS and Compassion Fatigue. We are often asked “what can I do personally and professionally to reduce the negative stress-related effects of my work?” We have many resources to recommend.

First, please have a look at the extensive list of TEND resources further down in the post, or also the wealth of articles we have posted in our resources section from other authors who are specialists in the field. If you are struggling with significant frustration with your workplace and feel that you do not have much control over the system or your job, and don’t feel that you can move to a better employment situation, please start by reading this article:  Beyond Kale and Pedicures

Where to start?

For starters, hopefully you will have read through our other posts to assist you in identifying the main challenges that you are facing: Is it related to too much exposure to difficult stories or a lack of referral resources? Is it work overload or an unsupportive supervisor/toxic team? Are you struggling with difficult personal circumstances that are affecting your ability to manage your stress? Do you feel overwhelmed with your complex case load and feel that you lack training in managing the most difficult and challenging situations? The answers will likely be as varied as there are professions and individuals reading these lines. So where can we start?

I will be honest, we often disappoint people who come to us for sound bites and “quick fixes” to these complex issues because, well, the solutions are complicated, just like the work that we do is multi-faceted and challenging. But here are some places to start:

Recent research in the field of STS and Compassion fatigue suggests that there are particular vulnerability factors that can increase your likelihood of being negatively impacted by the work. Take a look at this Venn Diagram 

Which of these factors are true for you?

Prior Trauma history/vulnerability factors

Do you have your own history of trauma? Are you currently struggling with a difficult family/personal circumstance? Do you have a history of mental illness or addiction that is currently re-emerging? All of these factors can contribute to increased vulnerability when doing high-stress, trauma-exposed work

Traumatic grief/loss in the workplace

Have you experienced losses at work? The death(s) of clients or patients, someone that you worked with who disappeared and never returned, providing you with no closure? A beloved colleague who died unexpectedly or retired or was laid off? The loss of a well-respected supportive supervisor or mentor? Significant changes to your workplace?

Direct exposure

Are you exposed to dangerous situations in your work? Have you ever been threatened, assaulted physically or verbally on the job? Is your work high-risk?

Secondary/Vicarious Trauma

Are you regularly exposed to indirect trauma at work? Hearing/viewing difficult case files, traumatic images and stories?

Compassion Fatigue

Have you experienced a shift in your ability to feel empathy for individuals you work with and/or colleagues or loved ones? Some situations can be very depleting – chronically desperate clients who don’t follow through on your recommendations and keep coming back in distress, a very large homogenous case load where all of the stories start sounding the same, years of exposure to traumatic stories that no longer generate any reaction in you.

Systems Failure

Many professionals describe experiencing moral distress around failures of the system: rules, laws and policies that you disagree with but are still mandated to comply with and that you feel are causing further harm, lack of referral resources and other injustices. All of these can lead to a pervasive feeling of anger and contribute to burnout and workplace toxicity and a decrease in the quality of care provided.

Burnout

Burnout can result from a negative overall workplace experience: your hours, your salary, your workload, the health of your work climate, rewards and recognition, who you immediately report to, the quality of your work relationships with colleagues and a perception of fairness and adequate support to do your job in the best way possible. A negative combination of these factors can lead to burnout.

 What works?

 First, take a look at which elements of the Venn Diagram are most salient for you and begin by addressing those that feel most manageable. As the saying goes “Dig where the ground is soft”. Seek support, formally with a good mental health practitioner or a coach, informally with colleagues and friends, look at ways to reduce trauma exposure in your personal/leisure time. Learn some stress-reduction techniques; get more training in trauma-informed practices which can be highly protective in retaining compassion when working with difficult cases and finally, please be open to the possibility of changing jobs if things are just too challenging where you are now. As Cheryl Richardson says in her book “Take time for your life” (1999) “Do not confuse difficult choices with no choice.” There is too much at stake to ignore compassion fatigue and secondary trauma.


WANT MORE? Here are some TEND resources to explore:

Live Training – bring one of our TEND associates to your organization for specialized training in resilience, compassion fatigue, etc.


Books – we carry 3 wonderful books (and e-books of each) written by our wonderful co-executives Françoise Mathieu and Dr.Patricia Fisher

Building Resilient Teams – a workbook designed as a practical, realistic and effective approach to building team resiliency and cohesion through a sequence of safe and respectful guided discussions.

Resilience Balance and Meaning Workbook – designed to provide you with practical help in addressing the effects of workplace stress, burnout and trauma. You will see that it is designed as a highly interactive tool and you are encouraged to make the book your own by responding to the frequent questions, reflections and self-assessments.

The Compassion Fatigue Workbook – a lifeline for any helping professional facing the physical and emotional exhaustion that can shadow work in the helping professions


Online Courses – TEND also offers online courses at a very affordable price, we do bulk discounts as well for larger groups. These courses are led by Dr.Patricia Fisher and Françoise Mathieu

Organizational Health in Trauma-Exposed Environments: Essentials – an intensive online course designed for managers and supervisors of teams working in high stress, trauma-exposed environments such as healthcare, the criminal justice sector, social and human services, emergency response, armed forces, education, child welfare, community mental health, non-profit organizations and related services

Compassion Fatigue 101 Online Course -Three-part webinar series that aims to help participants identify compassion fatigue, vicarious trauma and burnout, and participants will develop self-care strategies.

Resilience in Trauma-Exposed Work – This workshop will provide a solid framework to understand the mechanisms of stress and resilience within trauma-exposed environments, and will introduce practical, best-practices approaches to increasing resilience and enhancing individual wellness and organizational health.


Other Suggested Resources:

Compassion Fatigue/Vicarious Trauma/STS:

The Compassion Fatigue Workbook by Françoise Mathieu 

Trauma Stewardship by Laura Van Dernoot Lipsky

Organizational Stress:

Building Resilient Teams by Dr. Patricia Fisher, R.Psych., L.Psych.

Is work Killing You? A Doctor’s Prescription for Treating Workplace Stress by David Posen

Stress Reduction

Resilience, Balance & Meaning Workbook by Dr. Patricia Fisher, R.Psych., L.Psych.

Grounding Skills

 Graham, L. (2013) Bouncing back: rewiring your brain for maximum happiness. New World Library.

Tools for Managing Trauma:

NakazawaD.J. (2015) Childhood DisruptedHow your Biography Becomes your Biology. Atria.

 Van Der KolkB. (2014) The Body Keeps the ScoreBrainMind and Body in the Healingof TraumaPenguin Books.

ScaerR. (2014) The Body Bears the BurdenTraumaDissociation and Disease. Routledge.

MatéG. (2003When the Body Says No: Exploring the Stress/Disease Connection. Wiley & Sons.

Work/Life Balance:

Richardson, C. (1999) Take Time for Your Lifea 7 Step Program for Creating the Lifeyou Want. Broadway books.

Mindfulness & Selfcompassion websites

www.franticworld.com/free-meditations-from-mindfulness

www.self-compassion.org

www.mindfulselfcompassion.org

A Comprehensive Approach to Workplace Stress & Trauma in Fire-Fighting

An academic article by our very own Pat Fisher.

Do you have any firefighters in your lives that you know could use this information? Please share.

Excerpt: “Firefighters are exposed to a wide range of workplace stresses resulting in a wide range of negative physical, psychological, interpersonal and organizational consequences. This paper presents a comprehensive approach to workplace stress in fire-fighting. The Complex Stress Model encompasses the full set of workplace systemic and traumatic stresses encountered by firefighters. The risk/resilience factors, effects and outcomes of systemic and traumatic stress are reviewed, followed by a discussion of the challenges these pose to fire-fighting organizations. Within this framework, effective workplace wellness and organizational health initiatives need to incorporate three strategic elements: building capacity, increasing resiliency, and supporting positive culture change.”

Read the full article here.

The Future of Compassion Fatigue Education: Working Partnerships with Mental Health Professionals

*Reprinted with Permission

The concept of compassion fatigue (CF) has received increased attention in the animal care and welfare professions in recent years. This is a positive trend. Today, thanks to courses such as IAABC’s Animal Behavior Consulting: Principles & Practice, which contains a full module on compassion fatigue, people who work with animals are better able to access resources informing them that they are not alone in feeling depleted or altered by their work as caregivers for people and pets who are stressed, traumatized, sick, and in need of compassionate services.

However, as interest in compassion fatigue continues to grow, it’s important to be mindful of the quality of the resources being created to meet the increasing demand for compassion fatigue education. Just like dog training, compassion fatigue education is an unregulated industry. Anyone can advertise themselves as a compassion fatigue educator; there are no regulations or standardized training programs for this field. A variety of organizations do offer certificates programs for individuals who wish to become compassion fatigue educators. However, this process varies widely from one certifying organization to another, with some training programs being far more in-depth than others.

These certificates can be a good starting point for anyone interested in deepening their understanding of compassion fatigue, particularly management and leadership who wish to become better informed in order to support their staff and volunteers. But for those who intend to pursue a part- or full-time career in the compassion fatigue education field, the certification process alone will likely not be in-depth enough training to adequately build competency in safely engaging other people in this highly emotional, complex work.

Like their counterparts in professional dog training, professional compassion fatigue educators should demonstrate a commitment to ongoing education, support from other professionals, and clearly communicated boundaries that recognize the limitations of their skills and role.

Read the full article below:

The Future of Compassion Fatigue Education: Working Partnerships with Mental Health Professionals

New Curricula Build Resilience in Young Medical Professionals

Maclean’s Magazine recently published an article stating that approximately 29% of young doctors experience symptoms of depression or receive a clinical diagnosis. Why? Part of the problem lies in the immense competition young doctors face to obtain jobs. The culture of residency, where young physicians are often required to work excessive hours to stay competitive, is cited as a major source of mental health deterioration. Perhaps most obvious are the stresses associated with making difficult, life-and-death decisions with little to no experience.

Compounded, these issues are causing a mental health crisis among young health-care providers across Canada, and particularly medical students. Lack of sleep, stress and poor self-care contribute to diminishing mental health. Zane Schwartz writes that there is hope: “Young doctors across Canada are trying to change [the] statistics, encouraging struggling peers to seek support and building programs that make it easier for them to take care of themselves…the new curriculum for the University of Toronto, rolling out this fall, which will include several weeks of resiliency training.” Resiliency training is at the forefront of efforts seeking to help future medical professionals cope with the stresses of their work. At UoT, Shayna Kulman-Lipsey, Manager of Counselling has launched a number of initiatives aimed at breaking the stigma attached to seeking help. She argues that the ability to gain resiliency is dependent, in part, on reaching out to peers for support, which can be difficult in an environment that stigmatizes asking for help as a sign of weakness. If medical students develop the skills to maintain resiliency earlier in their careers, they will be better equipped to take on high-stress workplaces and maintain high levels of patient care later.

In the United States, a similar need has been identified by the American Academy of Pediatrics (AAP). This month, the AAP released a special article in Pediatrics, the Official Journal of the AAP titled “The AAP Resilience in the Face of Grief and Loss Curriculum” authored by a group of physicians from across the United States. According to the publication, The AAP Section on Medical Students, Residents and Fellowship Trainees identified a need to address the management of grief and loss that health care professionals experience throughout their careers. The development of this new curriculum was endorsed and sponsored by the  AAP Section on Hospice and Palliative Medicine.

A large portion of the new AAP curriculum focuses on the physician-patient and physician-family relationship, with modules designed to help pediatric health-care professionals learn to communicate effectively with children and their parents. The last section of the curriculum, Part D: Introduction to Personal Well-Being, has been developed specifically to address physician well-being. Like the folks at UoT, the authors here argue that teaching medical students personal strategies to cope with stressful events in the workplace will promote long-term well-being and resiliency as their careers progress. The new curriculum recommends a Wellness Learning Plan, that “might be incorporated at the beginning of medical school and reviewed with the student’s advisor or mentor quarterly.” While the AAP publication is specific to the experiences of grief and loss, the message is more broad: resiliency is critical in maintaining personal well-being in high-stress, trauma-exposed workplaces. Educating students early in their careers with these types of curricula may offer longer-term prevention of burnout, fatigue and secondary traumatic stress.

To read more about programs for medical students at the University of Toronto, please visit:  http://www.md.utoronto.ca/Annual_Report/learner-experience/resilience

To learn more about the new “AAP Resilience in the Face of Grief and Loss Curriculum”, please visit: http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/06/peds.2016-0791.full.pdf

Maclean’s article: http://www.macleans.ca/education/new-curriculum-addresses-mental-health-for-young-doctors/

Beyond Kale and Pedicures

Beyond Kale and Pedicures: Can We Beat Burnout and Compassion Fatigue?

Françoise Mathieu, M.Ed., CCC.

“I have been locked out of the seminar room. Peering through the glazing, I can see two dozen operating room nurses in scrubs, milling about inside the auditorium. The space is nearly full, and they are chatting and eating lunch. The session on compassion fatigue and self-care is about to begin, but the door is locked and I can’t get in. I knock once, and then again a little bit louder. They can see me, but no one comes to unlock the door. Problem is, I am the presenter, and this isn’t starting out particularly well…”

Read the full article here: BEYOND KALE AND PEDICURES Article

“Secondary Traumatic Stress and the Ottawa Shooting: What happens when we all go back to our regular lives?”

Today, October 22nd, marks the 1-year anniversary of the tragic shootings at Parliament Hill in Ottawa, Ontario. As we honour and remember Cpl. Nathan Cirillo, we also pay tribute to the first responders, paramedics, police officers and Ottawa citizens that rushed to the scene. We recall a nation in mourning and the millions of Canadians shocked, saddened and scared by the traumatic scenes splashed across the media. How did this happen? What comes next? How will we cope?

Following the shooting last year, Francoise wrote this piece entitled “Secondary Traumatic Stress and the Ottawa Shooting: What happens when we all go back to our regular lives?” Today seems like the perfect time to reflect and to think critically about secondary traumatic stress, and particularly the STS experienced by those directly and indirectly affected by this shooting.

The article is available below in French & English.

“Secondary Traumatic Stress and the Ottawa Shooting: What happens when we all go back to our regular lives?”

“Le stress traumatique secondaire et la fusillade d’Ottawa : Qu’arrive-­t-­il après notre retour à la vie de tous les jours?

Maclean’s Magazine recently published an article on the coping strategies used by those first on the scene after Cpl. Nathan Cirillo was shot. Click here to read more.

How to Outsmart your Negative Brain

CARE4YOU: The Fifth Annual conference on Compassion Fatigue, Secondary Traumatic Stress and Burnout is designed to care for those who care for others. This year, the program was developed around the theme of “Creating Change Agents”. The Conference will be held in Kingston, On. June 9-10, 2015.

This week, we highlight some of our exciting speakers and topics

How to Outsmart your Negative Brain With Daniel Doherty

Do you ever find it challenging to separate your work and personal life?

Helping professionals often feel personally invested in their caring roles – after all, we are caring individuals. There are great rewards for your investment, but there can also be a great personal cost attached to helping others. It can become difficult to separate work from home, and sometimes affects our personal relationships. Our go-to coping mechanism is often detachment from work and home. While we hope to be protecting ourselves, catching our breath, relaxing, and re-charging, the end result of detachment can lead to simply basking in negative thoughts.

Daniel Doherty tackles these issues in his presentation ‘How to Outsmart Your Negative Brain.’ During this session, Daniel will help participants understand the effects of stress hormones adrenaline and cortisol on our limbic system and pre-frontal lobes. Neuropsychologist Rick Hanson, Ph.D., believes the brain has a built in “negativity bias.” Stress often reinforces this negative bias and also diminishes and/or decreases the useful effects of our “happy hormones.” By understanding our brains when they are stressed, we can take advantage of those “happy hormones” oxytocin, dopamine, serotonin, oxygen.

Throw in some jalapeno peppers and 26 seconds to learn how to outsmart the negative intrusive thoughts that keep us in a fatigued state of mind.

Daniel Doherty, MSN, works at Christiana Care Health Systems in Delaware. Christiana Care Health System is one of the country’s largest health care providers that serves more than 600,000 patients yearly; recently Christiana was honored with the Magnet Award status for excellence in nursing by the American Nurses Credentialing Center. For the past 20 years, Daniel has gained experience in emergency nursing and staff development. Daniel has presented similar workshops on this topic to over 100 staff members at Christiana Care Health System and 34 police officers in the Wilmington Delaware Department. Daniel is also a part of the adjunct faculty with Delaware Technical & Community College. Delaware Tech is the State’s first community college, and seeks to inspire their mission of commitment, responsiveness, and vision on a national and state level.

For more information on CARE4YOU click here