The information in this article is adapted from “The Compassion Fatigue Workbook”
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 does not have the words to explain what is 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.
Developing a Warning System
Say 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.
Three Levels of Symptoms
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.
Take a look at the list below and notice which ones are your most frequent warning signs:
Physical Warning Signs
- Increased susceptibility to illness
- Sore back and neck
- Irritable bowel, GI distress
- Rashes, breakouts
- Grinding your teeth at night
- Heart palpitations
- 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 exhaustion
- Negative self-image
- Increased anxiety
- Difficulty sleeping
- Impaired appetite or binge eating
- Feelings of hopelessness
- 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
- Suicidal thoughts
Suicidal or hopeless thoughts? Get help: Remember that no matter how stressful and/or traumatic our work, 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. Don’t suffer alone. Get help. You deserve it and so do the people who love you.
Check out this additional post for more information on symptoms: Extra Information on Signs and Symptoms of Compassion Fatigue and Vicarious Trauma
Once you have read through and circled your most frequent warning signs, try and identify your top three most frequent 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.
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 or the availability of debriefing and grounding strategies. You may also 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 consider consulting with a well-trained mental health professional who is familiar with vicarious trauma and the nature of the work that you do.
Need more resources? Check out our online courses.
Resources for Organizations:
- Organizational Health in Trauma-Exposed Environments: Essential [Online Course]
- Developing Your Organizational Health Roadmap [Online Course]
- The Business Case for a Comprehensive Organizational Health & Workplace Wellness Program [Downloadable PDF]
- Building Resilient Teams: Facilitating Workplace Wellness & Organizational Health in Trauma-Exposed Environments [Book]
Resources for Individuals
- The Compassion Fatigue Workbook [Book]
- Resilience, Balance & Meaning Workbook [Book]
- Compassion Fatigue 101 [Online Course]
- Windows of Tolerance Framework (WTF): Strategies to keep helping professionals grounded and centered [Online Course]
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
The information in this article is adapted from “The Compassion Fatigue Workbook”
“What can I do personally and professionally to reduce the negative stress-related effects of my work?”
We have many resources to recommend. At the bottom of this page, you will find an extensive list of resources, recommendations and selected articles.
[Please note that the outside resources listed here are for reference and personal interest only. It is not intended as a recommendation or endorsement of organizations.]
Where to start?
For starters, it is helpful to identify 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?
We often disappoint people who come to us for sound bites and “quick fixes” to these complex issues – the solutions are complicated, just like the work that we do is multi-faceted and challenging. But here are some places to start:
Which of these factors are true for you?
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 your work:
Do you have your own history of trauma? Are you currently struggling with a difficult family/personal circumstance? Do you work with a population
that shares some of your own personal experiences of oppression and/or discrimination? 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?
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?
Are you regularly exposed to indirect trauma at work? Hearing/viewing difficult case files, traumatic images and stories?
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.
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 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.
First, take a look at which elements of this Venn Diagram are most salient for you, and begin by addressing those that feel the 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.
Online Courses: Cutting edge online training for high-stress and trauma-exposed workplaces. Discounts available for larger groups.
Building Resilient Teams by Dr. Patricia Fisher – 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 by Dr. Patricia Fisher – 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 by Françoise Mathieu – a lifeline for any helping professional facing the physical and emotional exhaustion that can shadow work in the helping professions
TEND Blog – frequent posts on topics related to stress, wellness, compassion fatigue and trauma from Françoise Mathieu, Dr. Patricia Fisher and TEND associates.
TEND Newsletter Archives – archived records of past TEND newsletters, a curated collection of resources related to wellness, burnout and stress.
Compassion Fatigue + Resiliency in Professionals – a Facebook group moderated by TEND that encourages discussions related to compassion fatigue and building resiliency in professionals from a vast array of professions and backgrounds
Other Suggested Resources
Trauma Stewardship by Laura Van Dernoot Lipsky
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
Resilience, Balance & Meaning Workbook by Dr. Patricia Fisher, R.Psych., L.Psych.
Graham, L. (2013) Bouncing back: rewiring your brain for maximum happiness. New World Library.
Tools for Managing Trauma:
Nakazawa, D.J. (2015) Childhood Disrupted: How your Biography Becomes your Biology. Atria.
Van Der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind and Body in the Healingof Trauma. Penguin Books.
Scaer, R. (2014) The Body Bears the Burden: Trauma, Dissociation and Disease. Routledge.
Maté, G. (2003) When the Body Says No: Exploring the Stress/Disease Connection. Wiley & Sons.
Richardson, C. (1999) Take Time for Your Life: a 7 Step Program for Creating the Lifeyou Want. Broadway books.
Mindfulness & Self–compassion websites
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.
*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:
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
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
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.
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.
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.
This week, we highlight some of our exciting speakers and topics
Emotional Freedom Technique: Creating Personal Change through Tapping With Diana Tikasz, MSW.
Do you ever feel stuck? Do you ever wish things would change, that you could be different? You are not alone. Too often we set resolutions, goals, and personal vows only to slip up and reach for that TV remote, that third chocolate cupcake and that second glass of wine. Making emotional changes is tough; we fall back on old patterns and give up on our goals. But deeper, lasting change is possible…especially if you have fun!
In her session, Diana Tikasz presents a powerful tool for creating personal change. ‘Emotional Freedom Technique’ is a simple acupressure technique that allows us to dig deeper and address the beliefs that can often sabotage our efforts and keep us feeling stuck. EFT has been growing in popularity because the simplicity of the technique can be applied to a wide variety of complex issues.
This workshop will provide hands-on training in the basics of EFT, and highlight emerging research that reveals a direct calming of stress in the body when EFT is applied. Diana will help teach you ways to create deeper emotional change that will stick. Be prepared to have fun and tap into your “silly side” as you learn this procedure. The session is designed to not only help you create your own personal change, but to also help others realize their goals.
Diana Tikasz, MSW has worked in the teaching and health care sector for the past 27 years. Her helping work began as an early childhood educator nurturing children and their families to reach their fullest potential. Over the course of her career she has worked in emergency department crisis teams, coordinated hospital based sexual assault/domestic violence treatment programs, which involved assisting individuals experiencing a current crisis, counselling those who have been traumatized by violence, and teaching other professionals how to do this work effectively while staying healthy themselves. She has also worked in various Employee Assistance Programs and private practise where she has specialized in working with individuals who are feeling stressed by their personal and/or work life. Diana grounds her work in current knowledge of the neuro-biology of stress and trauma and utilizes techniques/strategies that work on rebalancing holistically. Her passion is to assist people in creating personal, professional, and organizational changes that promote optimal health and make us more effective helpers.