Kara Dean-Assael Lydia Franco ... Compassion fatigue as secondary traumatic stress disorder: An overview

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  • Kara Dean-Assael

    Lydia Franco

    Clinical Lunch and Learn Webinar Series

    August 2014

  •  Welcome and Overview  The Role of Stress

    • Compassion Satisfaction • Compassion Fatigue • Burnout • Secondary Trauma

     The Importance of Self-Assessment  Building Resilience  Practical Ways of Coping:

    • Personal • Relationships • Workplace

     Resiliency Planning  Q&A

  •  There are at least three different types of stress, all of which carry physical and mental health risks: ◦ Routine stress related to the pressures of work,

    family and other daily responsibilities.

    ◦ Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.

    ◦ Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or in danger of being killed.

    (NIMH, Fact Sheet on Stress. 2014)

  •  Most Americans report feeling moderate-to- high stress levels.

     70-80% of all visits to the doctor are for stress-related and stress-induced illnesses.

     Stress can play a part in problems such as headaches, high blood pressure, heart problems, diabetes, skin conditions, asthma, arthritis, depression, and anxiety.

    (USDHHS: Healthy People; APA: Stress in America Survey; Mayo Clinic: “Chronic stress puts your health at risk.“)

  •  Most helping professionals find their work deeply satisfying

     Studies have found that social workers have higher levels of stress and burnout than workers in other occupations

     Social workers who experienced a higher level of burnout had greater decline in physical health (GI issues, headaches, respiratory infections)

    (Kim, Ji, & Kao, 2011; Grant & Kinman, 2014; Lloyd, King & Chenoweth 2002;

    Johnson et al. 2005; Collins 2008; Stalker et al., 2007)

  •  Please share an example of a way that work stress has affected you.

     What were the signs that you were affected by the stress (physical or emotional)?

  • • Compassion Satisfaction: Positive aspects of working as a helper

    • Compassion Fatigue: Negative aspects of working as a helper • Burnout

    – Inefficacy and feeling overwhelmed

    • Work-related traumatic stress

    – Primary traumatic stress direct target of event

    – Secondary traumatic exposure to event due to a relationship with the primary person

    (Stamm , 2009)

  •  The pleasure you derive from being able to do your work.

     Feel satisfied and enjoy your work

     Feel positive towards clients

     Feel you actually are helping others (“I make a difference”)

     Feel you are able to keep up with the work

    (Stamm, 2012)

  • http://muttscomics.com/ June 4, 2007

    http://muttscomics.com/ http://muttscomics.com/

  • “affects those who do their work well” (Figley, 1995)

     Shift in hope and optimism about the value of the work

     Deep physical, emotional and spiritual exhaustion  Compassion fatigued practitioners continue to give

    themselves fully to their clients, finding it difficult to maintain a healthy balance of empathy and objectivity.

     Can be a typical response to work overload; can ebb and flow depending on demands

     Two components: Burnout and Secondary Trauma

    (Mathieu, 2007;Pfifferling & Gilley, 2000)

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699394/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699394/

  •  Feelings of hopelessness

     Feelings of being emotionally exhausted and overextended by the work.

     Feelings of depersonalization which result in negative, cynical attitudes toward clients.

     Diminished personal accomplishment, reflecting a sense of lowered competence and a lack of successful achievement in work with clients.

     Associated with high workloads and non- supportive work environment

    (Maslach & Jackson, 1986; Stamm, 2012)

  •  Secondary exposure to extremely stressful events (exposure to others’ trauma or reexperiencing the person’s trauma)

     Symptoms rapid in onset and specific to a particular event

     Symptoms: Afraid, difficulty sleeping, images of upsetting event, avoiding the client and reminders of the event

    (Figley, 1995, Stamm, 2012)

  • 1. Personal concerns commonly intrude on my professional role.

    2. My colleagues seem to lack understanding.

    3. I find even small changes enormously draining.

    4. I can't seem to recover quickly after association with trauma.

    5. Association with trauma affects me very deeply.

    6. My patients' stress affects me deeply.

    7. I have lost my sense of hopefulness.

    8. I feel vulnerable all the time.

    9. I feel overwhelmed by unfinished personal business.

    Exercise only – Non-validated tool: http://www.aafp.org/fpm/2000/0400/p39.html


  • ◦ Yes to 1 item

    ◦ Yes to 2 items

    ◦ Yes to 3 items

    ◦ Yes to 4 or more

    Yes to 4 or more could be possible indicators of Compassion Fatigue.

  • Compassion




  •  What did you do to relieve the work stress we asked about earlier?

  •  Resilient social workers have: ◦ Work-life balance

    ◦ Reflective skills

    ◦ Flexible coping styles

    ◦ Empathy without over-involvement (emotional boundaries)

    ◦ Strong social support networks

    ◦ Social confidence

    (Kinman & Grant 2011; Grant & Kinman 2012)

  •  We have stressful experiences everyday in our jobs

     People are different: What is stressful to you, may not be stressful to others.

     Strengths come in identifying the stress and acting to manage it.

     Checking in about your stress levels on a daily basis can help to make you more aware of what you and your body are going through (e.g., stress thermometer)

    Volk, Guarino, Grandin, & Clervil, (2008)

  •  Many of us come with issues that are unresolved and can impact our lives and our work

     Do you have your own history of trauma? ◦ Very common

    ◦ What are your triggers?

    ◦ Are you getting help to help you cope?

    Volk, Guarino, Grandin, & Clervil, (2008)

  •  Key areas to examine: ◦ Sleep – most are sleep deprived which makes

    you more vulnerable to stress

    ◦ Exercise – even a little bit helps; do with a friend

    ◦ Diet – eat regularly or skip meals; healthy foods

    ◦ Unhealthy habits? Caffeine, smoking, drinking excessively

    ◦ Are you maintaining positive relationships?

    (Stamm, 2002)

  •  Do a check- in: How well do you take care of yourself?

     Utilize the Self-Care Checklist

  • Volk, Guarino, Grandin, & Clervil, (2008)

  •  How can we build mindfulness or self- awareness? ◦ Identify and recognize early signs of stress

    ◦ Identify your own personal strengths

    ◦ When have you felt particularly successful in your work?

    ◦ Try using the Self-Awareness Assessment to get you started.

  •  How can we build coping and problem- solving? ◦ What do we do or don't do to make things worse

    during stressful times?

    ◦ What do we do or don't do to make things better during stressful times?

    ◦ What can I do about it? How can you use problem solving techniques? How can you use coping techniques?

  •  Why do you do this work?

     Please chat in your responses.

     Tip: Write a brief personal mission statement and post it by your computer.

  •  Empathy = understanding ◦ Ability to understand and share the feelings of

    another (not your own feelings)

     Emotional boundaries support objectivity and reduces over-involvement in clients’ lives and your own distress

  • How do you know if you have good emotional boundaries?

  •  Stress can impact and strain relationships  Maintaining positive relationships helps to

    balance the stress one is experiencing  Decades of research have shown that there are

    tremendous benefits in having a network of supportive relationships.

    ◦ Individuals with robust social support networks have better health and well-being and longer lives.

    ◦ Support networks can make you more resilient in times of stress, setback, or loss.

    ◦ Social supports can also make the good times immeasurably better.

    ◦ Friends can even help you identify when you are stressed or distressed — in some cases they may notice it before you do.

    (Volk, Guarino, Grandin, & Clervil, 2008; Stamm ,2002)

  • ◦ What are you doing to build relationships?