Self Care Fridays Part one: Understanding Burnout and Compassion

Compassion Fatigue:
What’s New?
What Works?
Françoise Mathieu, M.Ed., CCC.
Certified Canadian Counsellor & Compassion Fatigue Specialist
•Background: Robin Cameron
My amazing team
Rebecca Brown, MSW RSW
Diana Tikasz, MSW RSW
Meaghan Welfare, BA
Lori Tomalty-Nusca, ECE
Ten Years On…
•Walking the Walk CF workshop has been offered to
thousands of Canadians across the country
•Nurses, social workers, MH counsellors, PSWs, teachers,
physicians, allied health professionals, victim service
workers, court reporters, lawyers, judges, ministers,
chaplains, police officers, paramedics, prison staff,
alzheimers societies, palliative care…
•Approx 300 CF Educators trained through Train the Trainer
•Various organizations implementing CF education as part of
their staff wellness plan (Peel Region, York Region, Bruyere
Continuing Care, Yukon and NWT Victim Services, to name
a few).
•Now: more attention being given to organizational health
and how agencies can help reduce/prevent CF-VT
The Current Reality…
•Deeply compromised system
•Ongoing challenges and cutbacks
•Difficult stories
•Increasingly complex cases (even in schools, end of life
•Big org health assessment – interviewed all staff
individually. What came out? Who coped well and who
•Those who struggled the most were: those who did not have
an external practice of some kind to manage their stress,
people who were angry and resentful and held on to it.
The Compassion Fatigue Workbook
Published by Routledge - December 2011
The expectation that we can be immersed in
suffering and loss daily and not be touched
by it is as unrealistic as expecting to be able
to walk through water without getting wet.
Remen, 1996
Compassion Fatigue
Vicarious Trauma
Moral Distress
Chronic stress
Compassion Fatigue
•A profound and gradual emotional and physical exhaustion that helping
professionals and caregivers can develop over the course of their career.
•An erosion of all the things that keep us connected to others in our
caregiver role: our empathy, our hope, our ability to tolerate strong
emotions/difficult stories in others, and of course our compassion - not
only for others but also for ourselves.
•Changes in our personal and professional lives: we become dispirited
and increasingly bitter at work, contribute to a toxic work environment,
more prone to clinical errors, violate client boundaries, lose a respectful
stance towards our clients. short-tempered with our loved ones and feel
constant guilt or resentment at the never ending demands on our
personal time.
•Can also happen to caregivers (“caregiver fatigue”)
Vicarious Trauma:
An Occupational Hazard
Laura Van
Dernoot Lipsky
Vicarious Trauma
•Repeated exposure to difficult stories changes our view of
the world.
•Can cause nightmares, difficulty getting rid of certain
images, an intense preoccupation with a particular story or
event we’ve been exposed to.
•”When external trauma becomes internal reality”
Lipsky 2009 “Impacts the entire nervous system”
•Can happen through work (stories we are told or stories we
read) and through media exposure.
•Accumulates over time & across clients.
•Both CF and VT are occupational Hazards
• What happens to the stories you hear at work?
• What are your particular vulnerabilities?
• How do you protect yourself while doing this very
challenging work?
• Were you trained for this?
Primary vs Secondary
• Secondary Trauma: “Trauma reactions that involve other’s
trauma imagery or trauma stories” characterized by “panic,
horror or helplessness in relation to the event” (Tikasz)
• Primary Trauma:
• As a consequence of the work: e.g. EMS – car
accidents, fatalities involving children
• From our personal lives, our own past
• Post Traumatic Stress Disorder (PTSD)
Moral Distress
“[…] happens when there are inconsistencies
between a [helper’s] beliefs and his or her
actions in practice” (Baylis 2000)
•“when policies or routines conflict with […]
beliefs about […] patient care”
(Mitchell 2000)
• “Physical & emotional exhaustion as a result of prolonged
stress and frustration”
• Depleted ability to cope with work demands
• Sense of powerlessness to achieve goals
• Does not necessarily alter our view of the world, but our
view of the workplace
• Can happen in any occupation
Occupational Hazards
• We don’t get CF/VT because we
screwed up, we get it because we
• Vicarious Trauma is a natural
consequence of trauma exposure
Primary Trauma
Vicarious &
A workbook on
Beth Stamm (1995)
Current Research
Terminology - A need for more clarity
Beth Stamm: "The controversy regarding secondary trauma is
not its existence but what it should be called.”
• Nadine Najjar et al 2009 review of all the research to date on
compassion fatigue in cancer-care providers
• Conclusion: there still exists "an ambiguous definition of
compassion fatigue that fails to adequately differentiate it from
related constructs (e.g. burnout, secondary traumatic stress)."
• We are working on getting a set of working definitions we all
agree on, but we're not there yet.
Stamm (1995)
Najjar, Nadine et al (2009) Journal of Health Psychology, Vol 14(2) 267-277.
Some recent data
•Depending on the studies, 40-85% of health
care professionals were found to have CF
and/or high rates of STS
•57% of SW have been threatened, 16 %
physically assaulted
•40% of nurses physically assaulted
•52% military chaplains at medium to high
risk for anxiety and depressive disorders - this
is twice as high as the norm for CF members
and higher than general population
Some recent data
2009 AMA study of junior doctors
•54% met the criteria for CF
•69% met the criteria for burnout
•71% had lower than average levels of
job satisfaction
Markwell & Wainer, Doctors’ Health, MJA Vol 191, No 8, 19 Oct 2009
Data con’t
•2005 survey of the health of nurses (Canada):
8/10 nurses had accessed their EAP which is over twice
as high as the EAP use by the total employed
•DV lawyers: significantly higher levels of STS and
burnout compared to other mental health providers
•2011 study of US surgeons had thought about suicide
1.5-3 times more than the general population. Only 26%
of them had sought psychological help for their SI.
•US immigration judges higher levels of burnout than
hospital physicians and prison wardens
•59% of MH professionals are willing to seek help vs
15% of law enforcement professionals
Green Cross Standards of
Self Care Guidelines
First, do no harm to yourself in the line of duty
when helping/treating others
Second, attend to your physical, social,
emotional and spiritual needs as a way of
ensuring high quality services for those who
look to you for support as a human being
What Works?
7 steps individuals (and organizations)
can take to reduce CF/VT
What Works?
"the most significant factor associated with compassion
satisfaction” (Killian 2008 study of trauma counsellors)
"[...] most of the therapists interviewed observed that they
had not had any courses or specific training on professional
self-care, and this was an important but neglected area in
training.” Killian 2008
•Killian recommends that self awareness and self care
become integral parts of the curriculum for all helping
Killian, K.D. Helping Till it Hurts? A Multimethod Study of Compassion Fatigue, Burnout, and Self-Care in
Clinicians Working With Trauma Survivors in Traumatology, Vol 14, No 2, June 2008.
Step Two: Self Awareness
Dr Gabor Maté
Step Two: Self Awareness con’t
Long term effects of chronic stress
•“Our immune system does not exist in
isolation from daily experience.” (Maté,
2003, p.6)
Step Two: Self Awareness con’t
• Chronic stress: “chronically high cortisol
levels destroy tissue. Chronically elevated
adrenalin levels raise the blood pressure
and damage the heart.” (Maté, 2003 p.35)
• See p 35 for alzheimer’s disease eg.
Step Two: Self Awareness con’t
The “Gut” Feeling
• “[…] we have lost touch with the gut
feelings designed to be our warning system.
[…] We keep ourselves in physiologically
stressful situations, with only a dim
awareness of distress or no awareness at
Maté, 2003 p36
Self Awareness: a Key Strategy for CF/VT
•Being aware of our current feelings, actions and reactions
•Gaining an understanding and an awareness of how we deal with anger, hurt
and resentment
•Being aware of the dynamics from our past that influence the every day choices
we make: Why did you choose to go into this field and not another? Did you pick
this profession because of a trauma or loss you experienced in your own life?
Were you already a helper in your family of origin? Are you the go-to person in
your personal life? Do you feel empty or unimportant unless you are in a helping
•Understanding how your own childhood history affects your reactions to your
clients’ stories (countertransference)
•Being in tune with your stress signals: Do you have a good sense of how your
body communicates to you when it is overwhelmed? Do you get sick as soon as
you go on vacation, develop hives, get a migraine when you are stressed? Many
of us live in state of permanent overload and are dimly aware of it. What
happens when you feel angry? Do you explode or do you swallow your rage?
Where in your body do you feel your anger?
• Are you aware of the ways in which you sabotage your self care? (by saying
yes to requests you don’t have time for, by taking on more responsibilities, by
drinking excessively, by cancelling a therapy appointment…)
Step Two: Self Awareness con’t
Jon Kabat Zinn – Mindfulness Stress Reduction
“Stress Reduction in 6 parts” Video on Youtube
Mindfulness-Based Stress
• Article on website
• Book: Full Catastrophe Living by John
Mindfulness Stress
•Research on the effectiveness of MBSR is highly conclusive:
over 25 year of studies clearly demonstrate that MBSR is
helpful in reducing emotional distress and managing severe
physical pain.
•MBSR has been used successfully with patients suffering from
chronic pain, depression, sleep disorders, cancer-related pain and
high blood pressure. (Cohen-Katz et al, 2005)
•Based at Toronto's CAMH, Zindel Segal has developed a
mindfulness-based cognitive therapy program for treating depression
that has shown to be highly effective
•MBSR and Compassion Fatigue:
What works? Con’t
3) Rebalancing Caseload & Workload Reduction
"To combat compassion fatigue and burnout, agency administrators and
therapists may also wish to ask themselves "How many cases are too
many? ” Killian, 2008
What works? Con’t
4) Limiting Trauma Inputs
•Limiting media exposure/traumatic stories
•Low Impact Debriefing aka “sliming”
see my website for an article describing this process: “resources”
Step Four con’t - Limiting Trauma Inputs
Low Impact Debriefing
1) Increased Self Awareness
2) Fair Warning
3) Consent
4) Low Impact Disclosure
What works? Con’t
5) Improved Work/Life Balance
2009 Duxbury report on role overload in health care:
• 3/5 health care workers suffering from role overload
• 36% report high levels of depressed mood
• 1 in 4 employee was planning on leaving their job at the
hospital - not for higher pay, but for “greater control over
work hours and more respect”
Step Five Con’t
Take Time for Your Life
Cheryl Richardson
• The best Work-Life
balance resource
Step Five Con’t: Improved Work-Life Balance
Environment (clutter etc)
Body, mind and spirit
Cheryl Richardson, Take time for your Life (1999)
What Works?
6) Developing CF resiliency through relaxation training
and stress reduction techniques
Step 6 Con’t – Developing Resiliency
Help for the Helper: the psychophysiology of
compassion fatigue and vicarious trauma
What Works?
7) Accessing Coaching/Counselling/Clinical Supervision
as needed
A changing landscape,
for the better
•Increased recognition that this is an organizational
health concern (CSST report Summer 2007, Mental
Health at Works CMHA and Desjardins)
•The bottom line: high attrition, poor retention, soaring
costs of LTD and sick leave
Managing workplace toxicity
• Feeling wronged & bitter: A sense of helplessness, of
• “We become convinced that others are responsible
for our well-being and that we lack the personal
agency to transform our circumstances” Lipsky P93
Laura van Dernoot Lipsky (2009) Trauma Stewardship
Key Tools for Dealing
with CF
• Knowing your “big three”:
• Your warning signs: physical,
behavioural and psychological
The Warning Signs
Talking to my
Hiding from
ProQol Inventory
• Testing for CF, burnout and
Compassion Satisfaction
The Four Steps of CF Strategies
CF Strategies - The four steps
Step four
Make a commitment to
implement changes
Step three
Develop CF resiliency
Step two
Enhance self care
at home and at work &
Improve Work/Life balance
Step one
Take Stock of stressors at home and at work
Upcoming events
• The Compassion Fatigue Conference June
2011, Kingston.
• Workshop for Managers on Organizational
Health, June 2011, Kingston.
“The heart must first pump blood to itself”
Get in touch
• [email protected]