The Edge of Compassion – Françoise Mathieu giving a TEDTalk for TEDxQueensU

For the past 15 years, Secondary Trauma specialist and compassion fatigue educator Françoise Mathieu has been exploring tools to help all of us navigate the challenges of sustaining compassion and empathy towards others – both as individuals and professionals.

This talk explores ways to find the right balance between caring for others while staying healthy and empathic. Françoise is a Registered Psychotherapist and a compassion fatigue specialist. Her experience stems from over 20+ years as a mental health professional, working as a crisis counsellor and trauma specialist in university counselling, military, law enforcement and other community mental health environments.

Françoise is co-executive director of TEND, whose aim is to offer consulting and training to helpers on topics related to secondary trauma, compassion fatigue, burnout, self-care, wellness and organizational health. Since 2001, Françoise has given hundreds of seminars on compassion fatigue and secondary trauma across North America to thousands of helping professionals in the fields of health care, child welfare, the criminal justice system and other similar high stress, trauma exposed professions.

Françoise is the author of “The Compassion Fatigue Workbook” which was published by Routledge in 2012 as well as several articles and publications.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community.


 

compassion-fatigue-workbook-francoise-mathieu

“Françoise Mathieu’s writing is wonderful: she speaks from the heart, practitioner to practitioner, about the stressors and strains of human service work, particularly those that come from prolonged regular work with traumatized patients and clients. This is a book you help write by yourself and about yourself. That’s why it is the workbook for trauma work.” – Charles R. Figley, Tulane University, Louisiana, USA, and author of Treating Compassion Fatigue

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

The information in this article is adapted from “The Compassion Fatigue Workbook

Click here for downloadable PDF to share with your organization

 

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.

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

 

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

  • 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

  • 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

  • Emotional exhaustion
  • Negative self-image
  • Depression
  • Increased anxiety
  • Difficulty sleeping
  • Impaired appetite or binge eating
  • Feelings of hopelessness
  • Guilt
  • 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

 

Take Stock

 

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.

 

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 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.

Continue reading: Tools to Reduce Vicarious Trauma, Secondary Trauma, and Compassion Fatigue

Need more resources? Check out our online courses.

 


Resources for Individuals

 


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

The information in this article is adapted from “The Compassion Fatigue Workbook

Click here for a downloadable PDF to share with your organization

 

“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:

 

Personal Vulnerability

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?

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 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.


TEND Training

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

Online Courses: Cutting edge online training for high-stress and trauma-exposed workplaces. Discounts available for larger groups. 

Attend a TEND Conference

TEND Books

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 Resources

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

Secondary Traumatic Stress Consortium [Website]

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

New Course this fall – WTF: Essential Grounding and Debriefing Tools for Front Line Workers

Become more centered among the chaos

In the course of their work, many helping professionals are regularly exposed to difficult and sometimes traumatic material: anyone working in the criminal justice system, victim services, front line workers, those who work with forensic evidence and child exploitation, first responders, mental health crisis teams, homeless shelter staff and many others.

When there is a lot of exposure the risk for secondary trauma and compassion fatigue are high. How do we remain healthy and balanced while doing this challenging work? We need tools in our toolbox, skills that we can use before, during and after the difficult event has taken place. New research on grounding techniques and trauma reduction skills are showing promising results in helping to reduce secondary traumatic stress in trauma-exposed professionals.

This fall, we are delighted to begin bringing to you a brand new workshop designed by our very own Diana Tikasz, MSW, RSW. Diana has worked for many years in high stress, high trauma-exposed work settings and brings to this training her vast experience as a front line worker and supervisor, as well as the newest findings on the neuroscience of trauma exposure management.

WTF isn’t a swear word! It refers to the Window of Tolerance Framework. The WTF is our optimal zone – the place where we do our best work, when we are feeling calm yet energized, healthy and creative. Stressors and triggers can bring us out of that zone into high stress and reactivity, or into numbness and avoidance.

The techniques offered in this workshop will encompass the whole self as we can often retreat and get stuck in our heads. An emphasis will be on learning and incorporating strategies that change the way we work as opposed to using all our personal time to replenish what our work takes out of us.

This session will provide skills to help move yourself out of states of reactivity or avoidance and into the place of possibility to become more centered among the chaos. This is a crucial skill for front-line workers and others working with forensic evidence, investigations, court, witnesses and victims, and those working with individuals who have experienced difficult and traumatic experiences.

Those who would benefit are any folks in a helping profession that feel they are often overly stressed or hijacked by emotion, or those who are no longer enjoying their work and wondering whether they need to make a career change. Helpers who wish to learn specific skills that they can utilize to protect themselves in difficult situations whether it is working with those challenging clients, sitting in a difficult team meeting or interacting with a colleague who pushes your buttons. It is also for those who find that at times their personal lives are creating the WTF moments, which makes it extremely difficult to be present at work.

Diana: “I often say that helping work is even more difficult when the professional is going through their own personal stresses. We will focus on providing a framework and resources to help us navigate the storm. This workshop is especially for those who are feeling completely detached from what they are doing, feeling as though they are just “going through the motions” or counting down the days to retirement.”

 

 

 

 

“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.

Secondary Traumatic Stress and the Ottawa Shooting

 

Cliquez ici pour lire l’article en francais

Many people were directly impacted by the events in Ottawa last week – most affected, of course, was the victim’s family, the perpetrator’s loved ones, the good samaritans who rushed to Cpl Nathan Cirillo’s help, the paramedics and police officers who responded to the scene, all of the individuals inside the Parliament building who witnessed the gun fight, and everyone else who was on the Hill: those who spent hours in lockdown, the tourists and passersby who witnessed the attack, the media and a whole host of other people I am probably forgetting. Some of these individuals were directly exposed to a trauma while others experienced a more indirect form of traumatic exposure.

As one moves away from the epicentre of the tragedy, we can list millions of other individuals who were deeply affected by the shooting – Ottawa citizens, Canadian viewers who watched it on the news and of course the global community.  These folks were not exposed to direct trauma, but were potentially secondarily traumatized all the same: If you watched some of the raw media footage which was shown on our TV screens minutes after the shooting, you may have noticed some very graphic, rather disturbing images centered around the victim. I noticed that as the day progressed, while the footage was being shown in a continuous loop, it was slightly altered to mask some of the more disturbing elements of the scene.  (You may not have noticed that, but I have a homing device for trauma exposure in the public sphere and how it’s done, call it my own personal mission and obsession). However, with YouTube, and dozens of passersby able to film the scene with their smart phones, it won’t be hard to see that raw footage somewhere on the net, if one looks hard enough. I am not sure why the media outlets decided to stop showing the more graphic details – was it out of respect for the victim’s family? A decision to spare the viewers? Maybe a bit of both, and that’s a good thing. Too bad it doesn’t happen more often.

Thankfully, our degree of understanding of traumatic stress has significantly improved over the past decade – most people are now fairly familiar with the concept of Post Traumatic Stress Disorder (PTSD) and have no difficulty understanding that those at the centre of a tragic event like the Ottawa shooting might be significantly affected for weeks and perhaps months to come. We also know that some individuals are more vulnerable to traumatic stressors and may develop more significant psychological distress as a result of this event: the severity of the reaction is determined by a prior trauma history, a history of mental illness or addiction, a person’s personality and coping styles, whether or not they were able to seek good quality debriefing afterwards, the quality of their social supports and several other factors.

One thing is clear – when we experience a traumatic event, many of us have a strong need to talk about it with others. This is a very good thing. Talk, write, share with your loved ones, with your work colleagues and your friends. This urge to connect and tell our story can also happen to us during very intense happy events – talk to any new mother about her birth story hours or days after the delivery, and she will give you the play-by-play of each cube of ice she chewed on and what centimetres of dilation she was at. Talk to her again a year later, and she will likely tell you, in a nutshell, that “it hurt like hell and took 26 hours” but unless it was a very traumatic birth, she will no longer need to share minute by minute account of what happened. This is completely normal. With traumatic events that involve a criminal act, the need to share and the trauma experienced may be more potent. An “act of God” is very different from one human being’s deliberate decision to cause harm to others, even if the perpetrator is deeply psychologically troubled. So let’s talk about it, absolutely.

However, we should take care to share what is necessary vs “all the gory details” unless those are extremely central to our experience. After 9/11, the Globe and Mail (and many other news outlets) shared some incredibly graphic photos that I will never be able to remove from my mind – I was quite traumatized by those images,  and there were not necessary – I did not need to view these to be compassionate and profoundly distressed by the collapse of the Twin Towers. Fourteen years later, those photos of 9/11 still haunt me whenever I hear mention of the World Trade Centre. The same is true for the Bernardo trial, some 20 years later.

As the events in Ottawa recede, some of you may remain greatly shaken and very affected by the sounds, images and emotions surrounding the shooting. If, a few weeks from now, you feel that you are more distressed than you should be – maybe you are more upset than your colleagues, are having difficulty sleeping or focusing on other things, perhaps you are experiencing intrusive images or nightmares – please seek some support. Let’s take good care of one another.

Helpful Resources: 

Canadian Mental Health Association: Getting Help

CMHA Website on PTSD

© Françoise Mathieu 2014

Photo credits: Michel Loiselle