Kristen DeLange MS, LPC, NCC, CAADC Introduction 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 relaxation Cultivate skills necessary to prevent compassion fatigue through increased resiliency Discuss and identify how to increase support system Part I: Secondary Traumatization & Self-Care 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 Dominance Sympathetic Learned (trauma) Fight/flight/freeze Tense Hypervigilience Reduced brain operation Reactive Intimacy distance Stress hormones Parasympathetic 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 Symptoms Anxious Intrusive Reactive Heightened threat perception Sleep problems Lack of concentration Physical problems Separation thoughts Self-medication Work interfering with personal Feeling inadequate Avoidance Loss of energy, gratification, and hope -Gentry (2002) Causes of ST Past traumatic experience(s) Images Empathy Current safety concerns of the ones we help Children Nature of the work/setting Personal New staff -Saakvitne & Pearlman (1996) Secondary Trauma VS. PTSD Similarities Arousal Intrusion Avoidance Differences Listening vs. Experiencing Work affecting personal Level of distress/impairment Burnout Process, steadily worsens Gradual exposure to work stress and tension, attrition of optimism and ideals, with a lack of success/accomplishment Results in exhaustion, isolation, and decreased effectiveness -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 happening.” -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 pain 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 yourself 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 Relaxation-HR, muscle tension -Howard, P. (2006); Severin, S. & Severin T. (2005) Taking Spiritual Care Reading the Word, studying, committing it to memory Prayer Meditation and Listening (solitude) Fasting Worship Stewardship Submission Service Confession Guidance Celebration -Foster (1978) Taking Emotional Care Support, Support, Support! Individual Group Colleagues & Supervisors Loved Ones Personal Therapy Creativity Have fun! Exercises Toxic Waste Dump Reclaiming Letter -Saakvitne & Pearlman (1996) Maintenance 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. Obstacles? Solutions? Taking a Personal Inventory Make note of personal vulnerabilities Resiliency Plan Final Exercise What we do well & the rewards of our work Thank you! References 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: Bruner/Mazel. 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: http://www.ischool.utexas.edu/~ssoy/pubs/microcommunication/2micro.htm Covey, S. R., Merrill, A.R., & Merrill, R.R. (1997). First Things first. New York: Simon & Schuster.