Dottie Saxon Greene, PhD, LCSW, LCAS, CCS
East Tennessee State University
Assistant Professor, Department of Social Work
423-439-6569
greeneds@mail.etsu.edu
OVERVIEW
RATIONALE FOR THE TOPIC
COMPASSION FATIGUE, STS, VT, BO, AND
IMPAIRMENT
WHAT DOES THE RESEARCH SAY?
PROFESSIONAL AND ETHICAL RESPONSIBILITES
SELF-CARE
SELF-ASSESSMENTS
SELF-CARE, SELF-CARE, SELF-CARE,
Blah, Blah, Blah….. WHAT’S ALL THE
HOOPLAH ABOUT?
YOU ARE THE TOOL!
OUR CLIENTS DESERVE THE BEST WE CAN BRING
FORTH!
YOU DESERVE THE BEST YOU!
YOU CANNOT TAKE A CLIENT BEYOND THAT WHICH
YOU ARE!
SOCIAL WORKERS DON’T STOP BEING HUMAN
OCCUPATIONAL HAZARDS
NASW CODE OF ETHICS
CSWE COMPETENICES AND PRACTICE BEHAVIORS
TERMS/CONSTRUCTS
COMPASSION FATIGUE
BURNOUT
SECONDARY TRAUMATIZATION
VICARIOUS TRAUMA
IMPAIRMENT
Seminal works’ authors
Christine Maslach
Charles Figley
Beth Stamm
Pearlman & Saakvitne
PROFESSIONAL QUALITY OF LIFE:
Compassion Satisfaction
&
Compassion Fatigue
Courtesy of Beth Stamm, PhD
www.proqol.org
5
Professional Quality of Life (PROQL)
the quality one feels in relation to their work as a helper
• Compassion Satisfaction
– Positive aspects of working as a helper
• Compassion Fatigue
– Negative aspects of working as a helper
Burnout
– Inefficacy and feeling overwhelmed, unhappiness,
exhaustion, disconnectedness, insensitivity to work
environment
Work-related traumatic stress
– Primary traumatic stress direct target of event
– Secondary traumatic exposure to event due to a
relationship with the primary person
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Compassion Satisfaction
• The positive aspects of helping
– Pleasure and satisfaction derived from
working in helping, care giving systems
– Work is invigorating
• May be related to
–
–
–
–
–
Providing care
The system
Work with colleagues
Beliefs about self
Altruism
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SECONDARY TRAUMATIC STRESS
Preoccupied with thoughts of people helped
Feeling trapped, on edge, exhausted,
overwhelmed, and “infected” by others’ trauma
Inability to sleep
Forgetfulness
Inability to separate private life from helper life
Experiencing the trauma of someone helped
Can be identical to PTSD
Avoidance, arousal & numbing
Re-experiencing, intrusive recollection
Distress & impairment
8
VT: A process of cognitive [change] resulting
from [chronic] empathic engagement with
trauma survivors” (Pearlman, 1992, p. 52).
Shift in worldview related to beliefs to core beliefs
about
Sense of self
Safety
Trust
Intimacy
Control
Spirituality
(Pearlmann, 1998; Pearlmann & McIan, 1995; Pearlman & Saakvitne, 1995)
According to Figley (1995),
STS more related to behavioral sxs rather than
intrinsic cognitive changes
STS mimics PTSD
VT cognitive change process
“A state of physical, emotional, psychological,
and spiritual exhaustion resulting from chronic
exposure to (or practice with) populations that
are vulnerable or suffering (Pines & Aronson,
1998).
A process that occurs over time (indv &
organization)
Meta-construct
Exhaustion
Depersonalization
Reduction in one’s sense of personal
accomplishment
Professional Quality of Life
Compassion Satisfaction
The positive aspects
of helping
“The good stuff”
Compassion Fatigue
The negative aspects of helping
“The bad stuff’
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Relationships Are Complex
• Multiple spheres
– Work environment
– “People helped” environment
– Personal environment
• Positive (CS) & negative (CF)
• Altruism CS can override CF
• Compassion Fatigue two parts
– Worn out (BO) common
– Frightened, traumatized (STS) rarer but
powerful
13
Complex Relationships
Work
Environment
Professional
Quality
of Life
Compassion
Satisfaction
(ProQOL CS)
Exhaustion
Client
Environment
Compassion
Fatigue
Depressed by
Work
Environment
(ProQOL
Burnout)
Frustration
Anger
Secondary
Exposure
(ProQOL STS)
Personal
Environment
Traumatized
by work
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Primary
Exposure
Impairment Defined
According to Barker (2003),
an impaired social worker is one who is unable to
function adequately as a professional social worker and
provide competent care to clients as a result of a physical
or mental disorder or personal problems, or the ability or
desire to adhere to the code of ethics of the profession.
The problems most commonly include alcoholism,
substance abuse, mental illness, burnout, stress, and
relationship problem.” (p. 210)
15
Manifestations of Impairment
AOD use issues
Depression (3 xs the rate of general pop (Seibert, 2004))
Vicarious trauma
Secondary traumatization (PTSD-like sxs)
Burnout (70% lifetime rate (Seibert, 2005))
Compassion fatigue
Unethical conduct
Professional mistakes
Failure to provide competent care
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Manifestations of Impairment, cont.
Absenteeism
Cancelled appointments
Late for work
Pessimistic
Hoping for cancellations
Impatience
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Consequences of Impairment
Compromises performance
Jeopardizes client safety
Damages reputation of
agency/organization
Damaging to the reputation of social
work profession
Raises questions about the
competency of the profession as a
whole
Harms experienced by the distressed
social worker
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Social workers who identified the following
personal history issues were more likely to
experience professional impairment.
Alcohol and drug misuse by a parent,
partner, family member, or close friend;
Having a troubled parent
Physical, sexual, or emotional abuse.
Parentification as a child
Fledgling social workers are at higher risk for
compassion fatigue (CF) and burnout (BO)
compared to those who have longevity in the
field and are older in age. (Newell & MacneNeil,
2010; Salloum, Kondrat, Johnson & Olson, 2014)
Social workers are more likely to consider
leaving the field during their first four years in
practice (Whitaker, Weismiller, & Clark, 2006).
Bride, Jones, and Macmaster (2007) found with
child welfare workers that 92% of respondents
reported at least one symptom of STS at least
occasionally.
Salloum and associates (2014) reported 30% 60 % burnout rate
Seibert (2005) found 39% practicing SWers
currently experiencing BO with a nearly 75%
lifetime rate of BO
A study conducted for NASW found additional
work-related stressors which contribute to
burnout:
having more responsibilities than they can handle;
needing to complete routine task that have little intrinsic value;
having few opportunities for advancement/promotion;
being expected work long hours;
receiving few resources to adequately accomplish work tasks;
having conflicting or unclear job expectations;
getting minimal support form co-workers and supervisors;
and, being unable to balance professional and personal life.
(Arrington, 2008, p. 3)
PROFESSIONAL & ETHICAL
RESPONSIBILITIES:
NASW CODE OF ETHICS &
COUNCIL ON SOCIAL WORK
EDUCATION
Ethical principles of psychologists
2.06 Personal problems and conflicts
Code of ethics of the NASW
2.09 Impairment of colleagues
2.10 Incompetence of colleagues
ACA code of ethics
C.2g Impairment
C2.h Counselor incapacitation…
F5b Student & supervisor responsibilities
Impairment
AAMFT code of ethics
Principles of medical ethics (psychiatrists)
AMHCA code of ethics
(Zur Institute, n.d.)
NASW’s standard 2.09 mandates that:
(a) Social workers who have (b) Social workers who believe
direct knowledge of a
that a social work
social work colleague’s
colleague’s impairment
impairment that is due to
interferes with practice
personal problems,
effectiveness and that the
psychosocial distress,
colleague has not taken
substance abuse , or
adequate steps to address
mental health difficulties,
the impairment should take
and that interferes with
action through appropriate
practice effectiveness
channels established by
should consult with that
employers, agencies, NASW,
colleague when feasible
licensing and regulatory
and assist the colleague in
bodies, and other
taking remedial action.
professional organizations.
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NASW’s standard 4.05 mandates that:
(a) Social workers should not allow (b) Social workers whose personal
their own personal problems,
problems, psychosocial distress,
psychosocial distress, legal
legal problems, substance abuse,
problems, substance abuse, or
or mental health difficulties
mental health difficulties to
interfere with their professional
interfere with their professional
judgment and performance
judgment and performance or to
should immediately seek
jeopardize the best interests of
consultation and take
people for whom they have a
appropriate remedial action by
professional responsibility.
seeking professional help,
making adjustments in
workload, terminating practice,
or taking any other steps
necessary to protect clients and
others.
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NASW POLICY STATEMENT RE:
IMPAIRMENT
Since the ability to perceive situations
clearly and objectively is pivotal in social
work, impairment may compromise
performance and, thus, jeopardize the
rights of clients and treatment
effectiveness (NASW, 2008).
NASW POLICY STATEMENT RE:
IMPAIRMENT
NASW recognizes that the prevention,
identification, and treatment of professional
impairment is vital to protect the welfare of
clients, practicing social workers, the work
environment, and the integrity of the
profession. A multi-systemic approach, focusing
on prevention, identification, and treatment,
must be used to address professional
impairment among social workers (NASW,
2008).
COUNCIL ON SOCIAL WORK EDUCATION:
Educational Policy and Accreditation Standards
• Educational Policy 2.1.1—Identify as a professional social
worker and conduct oneself accordingly.
• Social workers serve as representatives of the profession, its
mission, and its core values. They know the profession’s history.
Social workers commit themselves to the profession’s
enhancement and to their own professional conduct and growth.
Social workers
• advocate for client access to the services of social work;
• practice personal reflection and self-correction to assure
continual professional development;
• attend to professional roles and boundaries;
• demonstrate professional demeanor in behavior, appearance, and
communication;
• engage in career-long learning; and
• use supervision and consultation.
NASW recognizes and acknowledges the unique
and valuable contributions of the professional
social worker. NASW supports the practice of
professional self-care for social workers as a
means of maintaining their competence,
strengthening the profession, and preserving
the integrity of their work with clients.
Education, self-awareness, and commitment are
considered key to promoting the practice of
professional self-care. (NASW, 2008, p.270)
“Process of purposeful engagement in practices
that promote holistic health and well-being of
the self” (Lee and Miller, 2013,p. 98).
“Professional self-care can be defined as the
utilization of skills and strategies by social
workers to maintain their own personal,
familial, emotional, and spiritual needs while
attending to the needs and demands of their
clients” (Figley, Stamm, and NASW as cited by Newell &Nelson-Gardell
(2014) p. 431).
Large caseloads
Caseloads with high acuity, chronicity, and trauma
Lack of client resources
Inadequate supervision
Restraints and limitations of bureaucratic systems
Inadequate compensation
Lack of professional support and professional
development opportunities
Safety concerns
Lack of recognition and autonomy
Organizational culture
(Cox & Steiner, 2013; Lee & Miller, 2013; Napoli & Bonifas, 2011; NASW, 2008; Newell & MacNeil, 2010; Newell &
Nelson-Gardell, 2014; Salloum et al., 2015; Seibert, 2005).
PREVENTION & INTERVENTION:
SELF-CARE
Mental health hygiene
Eat well
Sleep well
Exercise regularly
Humor
Spirituality
Mindfulness
Hobbies
Social support
Personal therapy
Vacation
Work-related self-care
Do NOT work overtime
Learn to say “No”
Regular supervision
Peer supervision
Advocate for manageable
caseloads
Professional development
activities
Do NOT bring work home
Organizational culture of
wellness
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The Burnout Measure, Short Version (Maslach-Pines, 2005)
Use the following scale
1
2
never almost never
3
rarely
4
sometimes
5
often
6
very often
7
always
1. Tired ______
2. Disappointed with people_______
3. Hopeless______
4. Trapped______
5. Helpless_______
6. Depressed_____
7. Physically weak/Sickly_____
8. Worthless/Feel like a failure____
9. Difficulties sleeping_______
10. “I’ve had it” _______
Up to 2.4 indicates low burnout; between 2.5-3.4 indicates danger signs; 3.5 4.4
indicates burnout; 4.5-5.4 serious problem of burnout; Score of 5.5 requires
immediate professional intervention.
36
References
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