Jan Laughinghouse, Ph.D., LCSW, LCAS, CSI
DISCLAIMERS
 Not a discussion of agency-specific issues
 Use of terms: therapeutic (read: healing); clinician
(read: staff, or insert your title); client (read: consumer,
individual, customer, resident, student or other
preferred title)
THE STRESSES OF HELPING
 Vicarious traumatization
 Modeling and reinforcing of workaholism
 Burnout or compassion fatigue
 Working in isolation (though among many)
 Underpaid and Undervalued
STRESS
 Most commonly accepted definition (attributed to
Richard Lazarus)
“Stress is a condition or feeling experienced when a
person perceives that demands exceed the personal
and social resources the individual is able to
mobilize.” (Source: mindtools.com/stress/UnderstandStress)
 Normal part of life
 Cannot be avoided
 Not always precipitated by negative events
EFFECTS OF STRESS
 Stress is a health issue that can affect us as follows:
 Lack of energy
 Trouble concentrating
 Sleep disturbances
 Increased anxiety
 Gastrointestinal problems (diarrhea, upset stomach)
 Muscle aches/tension
 Headaches
 Abuse of substances
 Fluctuations in weight (Source: Cleveland Clinic)
ASSESSING STRESS
 Holmes & Rahe Stress Scale (1967)
 Published as Social Readjustment Rating Scale (SRRS)
 Medical records of 5,000 patients examined
 Patients tallied 43 life events based on a relative score
 Determined positive correlation between patients’ life
events and their illness
 Subsequent research conducted to validate the link
between stress and illness
 Has cultural validity (tested on African American,
Caucasian and Hispanic groups; also with Japanese and
Malaysian groups) wikipedia.org
SCORES
 Score of 300+: At risk of illness (90% chance)
 Score of 150-299: Risk of illness is moderate (reduced
by 30% from the above risk)
 Score <150: Slight risk of illness
wikipedia.org
INTRAPERSONAL AND EXTERNAL
FACTORS THAT COMPOUND STRESS
 Intrapersonal
 Inherited personality traits
 Worldview
 How one processes information
 Inability to communicate with others
FACTORS (CONT’D)
 External
 Cultural background
 Health
 Religion
 Education
 Work history
 Living environment
 Socioeconomic background
STRESSES UNIQUE TO WORK IN HUMAN
SERVICES
 Emotional contagion (Miller, Stiff, & Ellis, 1988)
 Secondary traumatic stress (Figley, 2002)
 Traumatic countertransference (Herman, 1997)
 Compassion fatigue (Figley, 2002)
 Vicarious traumatization (McCann & Pearlman, 1990)
 Reactions that occur because “the process of empathizing with a
traumatized person helps us to understand the person’s experience of
being traumatized, but, in the process, we may be traumatized as well.”
(Figley, 1995, p.15)
 Along with vicarious trauma helping professionals
experience
 Professional crises (budget cuts, client death, violence
against a a colleague in the workplace)
 Community crises (natural disasters)
 Unfinished business from previous crises
 Current personal life crises (illness/death of a loved one,
divorce, financial crises)
WORKAHOLISM
(MODELED/REINFORCED)
 Overfunctioning is a learned behavior (Sussman,
1992).
 Characterizes the working style of many agencies and
clinicians
 Other-centeredness
 Vicious cycle
 Emotional exhaustion
 Fatigue
 Detachment
VS.
Accomplishment
Role satisfaction
Pleasure of engagement
(Figley, 2002; Norcross, 2000; Rupert & Kent, 2007)
BURNOUT/COMPASSION FATIGUE
 Occupational hazard (Figley, 1995; Pulido, 2007)
 Results from interacting intensely with people with
many severe problems over a long period with poor
support
 Symptoms are:
 Physical, mental, emotional exhaustion (“I’m worn out.)
 Insensitivity to others (I don’t care anymore.”)
 Sense of futility or hopelessness (Going out there to visit will not
change anything.”)
 Sense of isolation/invalidation (Who cares what we do anyway?”)
(Murphy & Dillon, 2011)
OTHER SIGNS

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Withdrawal from family and friends
Emotional numbing
Loss of interest in things enjoyed
Persistent thoughts and images related to the problems of
others
Physical symptoms such as a compromised immune
system, head and back pain, gastrointestinal disturbances,
muscle tightness
Sleep disturbances, including nightmares
Jumpiness; pervasive feeling of uneasiness or tension
Unethical activities (financial or sexual exploitation)
FEELINGS OF ISOLATION
 Poor support
 Lack of funding
 Organizational culture
 Feelings of disempowerment, lack of control, and
disenchantment similar to those of our clients
UNDERVALUED/UNDERPAID
 Historically undervalued, underpaid, and undersupported
 Other professions enjoy
 Greater pay
 Greater benefits
 Greater respect
 Does it matter that we
 Have education?
 Have years of experience?
 Provide an important community service?
 Are willing to work with populations marginalized by other
professions?
(Murphy & Dillon, 2011)
PERSONAL ASSESSMENT
Burnout Assessment
&
Discussion
STRATEGIES OF SELF-CARE
 Identify what sustains you and what does not
 Work settings
 Colleagues
 Types of support (Sweitzer & King 2009)
 Someone who listens without advising
 Sound advise when it’s needed
 Praise from “fans”
 Friends to relax and play with
 “Chicken soup people” who comfort
 People who challenge you to go further or deeper
SUPPORT (CONT’D)
 The companionship of “buddies” with whom you can
say or do anything without fear
 Affirmation and validation from people who’ve had
similar feelings or experiences (p. 27)
SELF-EMPATHY (Jordan, 1991)
 Value yourself
 Think about your needs differently
 Connect with others to experience
 Rest and renewal
 Support and validation
 Self-actualization
 Effectiveness at home and at work
(Murphy & Dillon, 2011)
TAKING PERSONAL TIME AND
SPACE
 Relax and nurture self
 Self care should be routine and not accidental
 Limit exposure
 Take some time away (personal/vacation time)
GOOD HEALTH PRACTICES
 Regular exercise
 Healthy diet
 Minimizing use of substances
 Caffeine
 Nicotine
 Alcohol/other drugs
 Work breaks
POWER OF HUMOR
 Cartoons
 Sayings
 Reflect on human folly
 Nothing that hurts or offends
THE VARIOUS MENTAL DISORDERS OF
WINNIE THE POOH CHARACTERS
(thejailbreak.com)
CONNECTING WITH LIKEMINDED OTHERS
 Family/friends
 Hobbies
 Cultural rituals
 Spiritual retreats
 Provide opportunities for creative expression, feedback,
and friendship
 Connections not made around discussions of workplace
stress
SPIRITUAL RESOURCES
 Meditation
 Mindfulness
 Prayer
 96 fifteen-minute blocks in 24-hour period
 Use 10-15 to pray/meditate

Help alleviate sleep problems due to worry
DO CREATIVE THINGS THAT PLEASE
YOU (Create meaningful experiences)
 Gardening
 Working out
 Sports
 Playing an instrument
 Quilting or knitting
 Listening to music
 Writing poetry
 Reading
 Cooking
TALK WITH OTHER STAFF
 Angry/negative ventilation in a peer group
 Exercise balance
 Too much negativity can lead to cynicism and
hopelessness
 Focus on examples of strength and resiliency
(Dr. Beverly Smallwood)
 Incorporate the “”hardiness factors
 Commitment
 Control
 Challenge (Dr. James Pennebaker)
HOW TO COPE: RECAP
“Burnout is a state of emotional, mental, and physical exhaustion caused
by excessive and prolonged stress. It occurs when you feel overwhelmed
and unable to meet constant demands. As the stress continues, you
begin to lose the interest or motivation that led you to take on a certain
role in the first place” (helpguide.org)
 Assess yourself
 Care for your physical and emotional well-being
 Acknowledge and express your feelings
 Limit exposure
 Create meaningful experiences in your life.
(Dr. Beverly Smallwood)
QUESTIONS?
REFERENCES
 Figley, Charles (Ed.). (1995). Compassion fatigue:
Coping with secondary traumatic stress disorder in
those who treat the traumatized. New York:
Brunner/Mazel
 Figley, Charles R. (2002). Compassion fatigue:
Psychotherapists’ chronic lack of self care. Journal of
Clinical, 58(11), 1433-1441.
 Herman, Judith. (1997). Trauma and recovery. New
York: Basic Books
REFERENCES (CONT’D)
 Jordan, Judith. (1991). Empathy and self-boundaries.
In Judith V. Jordan, Alexandra G. Kaplan, Jean Baker
Miller, Irene Stiver, & Janet Surrey (Eds.), Women’s
growth in connection: Writings from the Stone Center
(pp.67-80). New York: Guilford
 McCann, Lisa & Pearlman, Laurie Ann. (1990).
Vicarious traumatization: A framework for
understanding the psychological effects of working
with victims. Journal of Traumatic Stress Studies, 3,
131-149.
REFERENCES (CONT’D)
 Miller, K.I., Stiff, J.B., & Ellis, B.H. (1988).
Communication and empathy as precursors to
burnout among human services workers.
Communication Monographs, 55, 336-341.
 Murphy, B. & Dillon, C. (2008). Interviewing in action
in a multicultural world. (4th ed.). Belmont, CA:
Thomson Brooks/Cole
 Norcross, John C. (2000). Psychotherapist self care:
Practitioner-tested, research-informed strategies.
Professional Psychology: Research and Practice, 31,
710-713.
REFERENCES (CONT’D)
 Pulido, Mary L. (2007). In their words: Secondary
traumatic stress in social workers responding to the
9/11 terrorist attacks in New York City. Social Work, 52,
279-281.
 Rupert, Patricia A., & Kent, Jamie S. (2007). Gender
and work setting differences in career-sustaining
behaviors and burnout among professional
psychologists. Professional Psychology: Research and
Practice, 38, 88-96.
REFERENCES (CONT’D)
 Sussman, Michael B. (1992). A curious calling:
Unconscious motivations for practicing psychotherapy.
Northvale, NJ: Jason Aronson.
 Sweitzer, H. Frederick & King, Mary A. (2009). The
successful internship. Pacific Grove, CA: Brooks/Cole
Cengage.