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)
“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)
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
Fatigue
Compassion
Satisfaction
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?
◦ Are you expanding your support networks?
◦ Do you have friends you can speak with about how work affects you?
◦ Can you tell your friends and family not to expect you to solve their problems since you are “so good at it”?
Once you have identified supports you need to know how to activate these supports. Identify when you need help
Identify how you can ask for help
Ask for what you need
Helpful Tool: The “Breathe” supports are people who can be relied upon to notice, before you do, that you are either stressed or distressed. They intervene and offer support.
http://www.socialwork.buffalo.edu/students/self-care/documents/support/Identifying_Your_Breathe_Supports_-_Reiser.pdf
Volk, Guarino, Grandin, & Clervil, (2008)
Workplace Relationships ◦ Colleagues:
Colleagues can help listen and provide support Colleagues can see you struggling and let you know
◦ Supervisors: Support to process challenges and build coping Do you feel comfortable with your supervisor? If not, can
you change supervisors or add an outside supervisor?
You can also find non-workplace professional communities
Look for others in similar profession Virtual support groups or professional networks Remember confidentiality – share how you feel not your
client’s story
(Stamm, 2002)
How do you seek support from colleagues or supervisors?
How do you ask for help?
Can you see a variety of clients (e.g., mixing milder cases with more intense cases)?
Split seeing clients with administrative tasks Can you transition stagnant cases to other
services? Plan pockets of time to complete administrative
tasks during your day so you can leave work on time.
Have a transition time between seeing clients and going home.
At work, end your day with something positive. During commute, do something fun/enjoyable
unrelated to work. At home, take a few minutes to breathe before
transitioning to home responsibilities (e.g., enjoy family time, listen to music, etc.).
Switching on and off – See PocketCard
Keep Hope Alive!
(Stamm , 2002)
Warning signs:
◦ High rates of staff turn-over
◦ High rates of absences or tardiness
◦ Lack of communication and frequent miscommunication between co-workers and/or departments
◦ Increase in interpersonal conflicts between co-workers and/or between various parts of the organization
◦ Missed deadlines
◦ Incomplete work
◦ Poor quality of work or service delivery
◦ Increase in customer/client complaints
◦ A negative atmosphere/low morale
◦ Less energy and motivation to do “extra” or to take sufficient time to do quality work as an organization
◦ A lack of emotional and/or physical safety in the organization
Volk, Guarino, Grandin, & Clervil, (2008)
Review Organizational Self-Care Checklist with co-workers.
Are there any practices that can be put into place to create a more supportive environment?
What are simple strategies that can be implemented right away? (e.g., a check in at every staff meeting)
The ProQOL is free and available at www.proqol.org
A 30 item self-report measure of the positive and negative aspects of caring
The ProQOL measures Compassion Satisfaction and Compassion Fatigue
Compassion Fatigue has two subscales ◦ Burnout
◦ Secondary Trauma
Stamm (2009)
• Individual, personally – The ProQOL can help you plan where to put
your energy to increase your resilience
• Organizational planning – Can help organizations find ways to maximize
the positive aspects and reduce the negative aspects of helping
• Supportive Supervision – The ProQOL can be used as information for
discussions
Stamm (2009)
What is one thing you can start doing right away…
Personally?
Workplace?
Materials owned by ICL, Licensed by CTAC
http://www.socialworkers.org/pubs/news/2014/01/compassion-fatigue.asp
UB School of Social Work Self-Care Kit ◦ http://socialwork.buffalo.edu/resources/self-care-starter-
kit.html
http://www.compassionfatigue.org http://www.stress.org/ http://www.proqol.org/Home_Page.php Workbook for Those Who Work with Others: ◦ http://www.familyhomelessness.org/media/94.pdf
Organizational and Personal Self-Care Checklists: ◦ http://www.familyhomelessness.org/media/95.pdf
Figley, C.R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C.R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20). New York: Brunner/Mazel.
Figley, C.H. (2002). Treating Compassion Fatigue. New York: Routledge
Louise Grant and Gail Kinman: (2014) Emotional Resilience in the Helping Professions and how it can be Enhanced. Health and Social Care Education 3(1), 23-34
Maslach, C. and Jackson, SE (1986). Maslach Burnout Inventory Manual: Second Edition. Palo Alto: Consulting Psychologist Press.
Mathieu, F. (2007).Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 Self-Care Tips for Helpers. Workshops for the Helping Professions.
Pfifferling, J. H., & Gilley, K. (2000). Overcoming compassion fatigue. Family Practice Management, 7(4), 39-39.
Stamm, B.H. (2002). Quick-guide suggestions prevention/intervention with the negative effects of caregiving. http://www.proqol.org/Handouts.html
Stamm, B.H. (2009-2012). The PROQOL: Professional quality of life scale: Compassion satisfaction burnout and fatigue scale-Version V. Retrieved May 13, 2013, from http://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf
Rothschild, B. & Rand, M. (2006). Help for the helper: The psychophysiology of compassion fatigue and vicarious trauma. New York, NY: W. W. Norton & Company.
Volk, Guarino, Grandin, & Clervil, (2008). What About You? Workbook for Those Who Work with Others. The National Center on Family Homelessness.
Workforce Resilience Webinar Series
Part II: Enhancing Supervision:
Supporting our Workforce
Wednesday, September 24, 2014 12-1pm
Lydia Franco, LMSW
Kara Dean-Assael, LMSW
www.ctacny.com
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