Kristen DeLange
 Outline of the day
 Learning Objectives
 Discuss and identify the history and causation of
secondary traumatization, burn-out, and compassion
fatigue and their treatment
 Learn and practice tools for self-regulation and
 Cultivate skills necessary to prevent compassion fatigue
through increased resiliency
 Discuss and identify how to increase support system
Part I: Secondary Traumatization &
Why Self-Care and Secondary Traumatization?
“That which is to give off light must endure burning.”
-Viktor Frankl
Trauma and PTSD
 What is a traumatic event?
-DSM IV TR (2000)
 Posttramatic Stress Disorder
Sympathetic vs. Parasympathetic
 Learned (trauma)
 Fight/flight/freeze
 Tense
 Hypervigilience
 Reduced brain operation
 Reactive
 Intimacy distance
 Stress hormones
 Lack of TI
 Agile
 Relaxed
 Challenge
 Optimum Functioning
 Intentional
 Regulated
 Tolerance of intimacy
How Our Work Affects Us
What are 3 negative reactions/effects from your work
you have experienced?
-Saakvitne & Pearlman (1996)
Key Terms and Concepts
 Secondary Traumatization
 Burnout
 Compassion Fatigue
 Jung (1907)
Vicarious Traumatization &
Secondary Traumatic Stress
 “Harmful changes in professionals’ views of themselves,
others, and the world as a result of exposure to the graphic
and/or traumatic material of their clients.”
 Secondary Traumatic Stress-”a set of psychological
symptoms that mimic posttraumatic stress disorder but is
acquired through exposure to persons suffering the affects
of trauma.”
-Baird et al (2006)
Secondary Traumatic Stress
 Anxious
 Intrusive
 Reactive
 Heightened
 Sleep problems
 Lack of
concentration 
 Physical
 Separation
 Self-medication
Work interfering
with personal
Loss of energy,
and hope
-Gentry (2002)
Causes of ST
Past traumatic experience(s)
Current safety concerns of the ones we help
Nature of the work/setting
New staff
-Saakvitne & Pearlman (1996)
Secondary Trauma VS. PTSD
 Arousal
 Intrusion
 Avoidance
 Listening vs. Experiencing
 Work affecting personal
 Level of
 Process, steadily worsens
 Gradual exposure to work stress and tension, attrition
of optimism and ideals, with a lack of
 Results in exhaustion, isolation, and decreased
-Cherniss (1980); Maslach (1976, 1982); Soy (2002)
Compassion Fatigue
 Compassion Fatigue =
Secondary Traumatization + Burnout
-Figley (1995)
How Can We Heal From This?
 Healing compassion fatigue-relaxation, building and
maintaining relationships (personal and colleagues),
sharing narratives (anonymity)
 Healing of burnout-relaxation/self-regulation +
changing perceptions and increased work support
 VT-Awareness, Balance, Connection
-Gentry (2002); Saakvitne & Pearlman (1996)
Healing Exercises
 Breathing
 Mindfulness: 3-2-1
 Assignments:
 Mindful eating
 Journal
 Favorite verse(s) regarding God’s character
-Gentry (2009)
Part II: Self-Care
 Review
 Mindfulness
“Mindfulness can be thought of as moment-to-moment, nonjudgmental awareness, cultivated by paying attention in a
specific way, that is, in the present moment, and as nonreactively as possible…mindfulness is perhaps the most basic,
the most powerful, the most universal, among the easiest to
grasp and engage in, and arguably, the most sorely needed
now. For mindfulness is non other than the capacity we all
already have to know what is actually happening as it is
-Kabat-Zinn (2005), pp. 108-109
Mindfulness Cont.
 observe, describe, participate, non-judgmental stance,
focus on one thing in the moment, be effective
 Exercise
-Linehan (1993)
Mindfulness Cont.
Research has shown that mindfulness helps to decrease
worry and anxiety, heart problems, substance abuse,
depression, stress, smoking urges, insomnia, and chronic
Orsillo & Roemer (2011)
Intentionality & Acceptance
 “Pain is inevitable, suffering is optional”-Frankl
 Radical Acceptance-Linehan (1993)
4 Ways to Respond to a Crisis:
1. Solve it
2. Change how you think/feel about it
3. Accept it
4. Stay miserable
Acceptance does not equal agreement or resignation!
Intentionality & Acceptance Cont.
 What happens when we accept?
 Pain + Non-acceptance = Suffering
 Pain + Acceptance = Normal Pain
 Intentionality: to address STS symptoms, to grow
professionally and personally, finding balance and
taking care of self in order to fully live out God’s calling
for our lives.
-Gentry (2009)
My Mission Statement
 Empowering, represents the deepest and best within
 Fulfillment of your distinctive gifts to contribute and
fulfill God’s call on your life (in all areas)
 Vision + Values
 Written to inspire you and you alone
Taking Physical Care
 Breathe!
 Exercise-Aerobic 3x/week or more + anaerobic
 Sleep
 Nutrition
 Spend time outdoors
 Massage, stretch, acupuncture, progressive muscle
 Relaxation-HR, muscle tension
-Howard, P. (2006); Severin, S. & Severin T. (2005)
Taking Spiritual Care
Reading the Word, studying, committing it to memory
Meditation and Listening (solitude)
-Foster (1978)
Taking Emotional Care
Support, Support, Support!
Colleagues & Supervisors
Loved Ones
Personal Therapy
Have fun!
 Toxic Waste Dump
 Reclaiming
 Letter
-Saakvitne & Pearlman (1996)
 Why maintain our commitment?
 I am in pain
 I matter
 The ones I help matter
 The ones I love matter
 The work I do matters
 It is imperative
-Saakvitne & Pearlman (1996)
Maintenance Cont.
 How can we maintain our commitment?
 Not on your own: support person/group
 One day at a time
 Do something in each area
 Make one change at a time
 Increase acceptance and mindfulness
 Realistic and non-judgmental
 Don’t forget, don’t give up
-Saakvitne & Pearlman (1996)
Maintenance Cont.
Taking a Personal Inventory
 Make note of personal vulnerabilities
 Resiliency Plan
Final Exercise
 What we do well & the rewards of our work
 Thank you!
 American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.
American Psychiatric Association, 2000.
Baird, K., & Kracen, A.C., “Vicarious Traumatization and Secondary
Traumatic Stress: A research synthesis.” Counselling Psychology
Quarterly, Volume 19, Number 2, June 2006 , pp. 181-188(8). Routledge,
part of the Taylor & Francis Group.
Cherniss, C. (1980). Professional Burnout in Human Services
Organizations. New York: Praeger.
Figley, C. R., (1995). Compassion Fatigue: Coping with secondary
traumatic stress disorder in those who treat the traumatized. New York:
Foster, R. (1978). Celebration of Discipline. New York: Harper Collins.
Frankl, V. (1963). Man’s Search for Meaning. New York: Washington
Square Press, Simon and Schuster.
References Cont.
 Gentry, J. E. “Compassion Fatigue: A crucible of transformation.”
Journal of Trauma Practice, Spring 2002.
Gentry, J.E. (2009). “Compassion Fatigue” from PESI.
Gentry, J.E. (2009). “Trauma: Tools for Stabilization and
Recovery” from PESI.
Howard, P. (2006). The Owner’s Manual for the Brain, 3rd Ed.
Austin, TX: Bard Press.
Jung, C.G. (1907) The Psychology of dementia praecox. Read, M.
Fordham, G. Adler and W. McGuire (eds.), The Collected Works
of C.G. Jung, H. Vol. 3. Bollingen Series XX, Princeton: Princeton
University Press.
Kabat-Zinn, J. (2005). Coming to Our Senses: Healing ourselves
and the world through mindfulness. New York: Hyperion.
References Cont.
 Linehan, M. M. (1993). Skills Training Manual for Treating
Borderline Personality Disorder. New York: The Guilford Press.
Maslach, C. (1976). “Burnout.” Human Behavior, 5, 16-22.
Maslach, C. (1982). Understanding Burnout: Definitional issues
in analyzing a complex phenomenon. In W.S. Paine (Ed.) Job
Stress and Burnout: Research, theory and intervention
perspectives (pp. 29-40). Beverly Hills, CA: Sage Publications.
Orsillo, S. & Roemer, L. (2011). The Mindful Way Through
Anxiety. New York: The Guildford Press.
Saakvitne, K.W., & Pearlman, L.A. (1996) Transforming the Pain:
A workbook on vicarious traumatization. New York: Norton.
Severin, S. & Severin, T. (2005). TriEngergetics: Balancing
nutrition, exercise, and mindfulness. Oakland, CA: New
Harbinger Publications, Inc.
References Cont.
 Smith, J. (2012). “Dialectical Behavior Therapy 5-Day
Comprehensive” by MACMHB.
 Soy, S. (2002). “Communication, Social Support, and
Burnout: A Brief Literature Review.” World Wide Web:
 Covey, S. R., Merrill, A.R., & Merrill, R.R. (1997). First
Things first. New York: Simon & Schuster.

When caring hurts - International Teams