Care for the
Caregiver:
Addressing
Compassion Fatigue
Marsha I. Wiggins, Ph.D.
Licensed Marriage & Family Therapist #
MT2567
Kaleidoscope Counseling & Consulting, LLC
(561) 247-COPE (2673)
West Palm Beach, FL
www.westpalmbeachcounselor.com
Objectives:
At the end of this workshop you will
be able to:
Verbalize the Compassion Fatigue
syndrome and the signs and
symptoms of Compassion Fatigue.
2. Discuss ways of prevention and
overcoming of Compassion Fatigue
1.
Biblical Bases for Compassion
In the Hebrew scriptures the term,
“hamal” means to have pity, to spare,
to have compassion as with
Pharoah’s daughter taking
responsibility for baby Moses (Exodus
2:6)
“Raham” means to love deeply to
have mercy
Biblical Bases for Compassion
In the Christian Testament,
“Eleos” means mercy, an emotion
aroused by contact with a person who
is suffering, accompanied by giving
help
Luke 6:36: “Be merciful, just as God is
merciful.”
Biblical Bases for Compassion
Oiktirmos—mercy or compassion,
torn of heart at the sight of another’s
suffering
The Lord is full of compassion and
mercy (James 5:11) and believers are
urged to put on a heart of compassion
(Colossians 3:12-13)
(Richards, L. O. (1991). Expository Dictionary of Bible Words. Zondervan)
Application
To express compassion is to imitate
God’s mercy and compassion (Luke
6:36)
To convey compassion is
accomplished by reliance upon God
as the branch draws energy from the
vine (John 15:4-5)
Exactly What Is Compassion Fatigue?
Defined as “State of exhaustion and
dysfunction (biologically,
psychologically and socially, spiritually)
as a result of prolonged exposure to
secondary trauma or a single intensive
event.
Series of psychosocial and emotional
factors caused by a specific event or
events indirectly affecting helpers.
Emotional fallout from delivering
services to those who were primarily
traumatized.
(C.R. Figley, 1995)
Compassion Fatigue In Many Forms
Healthcare Professions
Physicians, Nursing, Social Services, Mental
Health Providers
Other Helping Professions
Teachers, Clergy, Attorneys, Disaster Site
Clean-up Crews, Animal Shelter staff etc.
Fire, EMS, Law Enforcement
Family Care Givers
Charitable Giving workers
Animal rescue workers
(Philpot, Sue)
Menu of Misconceptions that Lead
to Compassion Fatigue
“I will ‘fix’ the problem…make
everything OK…save the world.”
“ I am responsible for outcomes.”
“If I care enough, everything will be
OK.”
The hurting people I help will
appreciate everything I do for them.”
More myths…
“I will have enough resources (time
money, material, skills, training) to fix
things.”
“Significant people in my life will
support and approve my absence
from this relationship while I invest in
this compassionate mission.”
“I know what I’m getting into.”
And other myths…
“ I can do it alone.”
“If I’m spiritual enough, I can deal with
the stress of working with suffering
people.”
(Wood, Samuel)
The Compassion Fatigue Trajectory
Becoming a victim of Compassion
Fatigue follows a predictable pattern
of 5 phases:
1. ZEALOT PHASE
2. IRRITABILITY PHASE
3. WITHDRAWAL PHASE
4. ZOMBIE PHASE
5. VICTIMIZATION
ZEALOT PHASE
In the Zealot Phase caregivers…
Committed, involved, available
Solving problems/making a difference
Willing to go the extra mile
High enthusiasm
Volunteers without being asked
IRRITABILITY PHASE
In the Irritability Phase caregivers…
Begin to cut corners
Begin to avoid clients
Begin to mock co-workers and clients
Begin to denigrate the people they serve
Use inappropriate humor
Make mistakes
Distance selves from friends & co-workers
ZOMBIE PHASE
In the Zombie Phase caregivers…
Hopelessness turns to rage
Begin to hate people…any/all people
Judge others as incompetent or
ignorant
Develop a disdain for clients
Lose patience, sense of humor, time
for fun
VICTIMIZATION
In this phase, caregivers…
Become overwhelmed and consider
leaving their profession or volunteer
posts
Experience physical illnesses
Have perpetual symptoms
(Wood, Samuel)
A Model of Stress & Coping
McCubbin & McCubbin (1989) found:
Resources + Pile Up of Demands + Perceptions
Influences the way people respond to a major
stressor.
Also, the level of adaptation to stress is also based
on individuals’ resources ($, social/family support,
spirituality etc.), Pile Up of Demands (a laundry list
of other stressors) and Perceptions (how
individuals view and make sense of their life
circumstances)
The Process
Why Not “Burnout”
Defined as: “Exhaustion of physical or
emotional strength or motivation
usually as a result of prolonged stress
or frustration”
(Merriam-Websters Collegiate Dictionary)
Gradually builds to a breaking point
and the stress and frustration comes
from all types of work-related
stressors
Burnout
Usually takes longer
Compassion Fatigue may be a
contributing factor
Frustrations such as
Paper work and “red tape/bureaucratic
issues”
The environment (home and work)
Colleagues
Pace and or grind of work
Burnout
Burnout is losing all satisfaction at
work as a result of long hours, too
much stress, & overwork.
Compassion Fatigue vs. Burnout
Compassion fatigue is a debilitating
weariness brought about by repetitive,
empathic response to pain and
suffering. With compassion fatigue,
you are absorbing the trauma through
the eyes and ears of your clients.
The Difference?
Ask the Question:
“Do I Love My Job?”
Yes
NO
Compassion
Burnout
Fatigue
(Philpot, Sue)
Who is More Likely to Develop
Compassion Fatigue?
Anyone with the capacity for true
compassion, empathy, concern and
caring
We try to stay within professional
boundaries and adhere to training
guidelines
But the greatest strength
(compassionate connection) is also
greatest vulnerability
Not a characteristic to give up
Compassion Fatigue
Recognize the symptoms
Educate yourself
Recognize that:
The more prolonged exposure
Working long hours
More personal demands
More isolated you allow yourself to
become
Increases your vulnerability
Warning Signs and Symptoms
Symptoms similar to post-traumatic
stress disorder (PTSD) but from
secondary exposure
Additionally cynical, discouraged or
hopeless attitude about work or
career
Paradoxically you find it difficult to
leave work at the end of the day
Have recurring thoughts about a
particular case
Symptoms
Cognitive
Emotional
Behavioral
Spiritual
Personal
Relationships
Physical/
Somatic
Work
Performance
Lowered
concentration
Decreased
self-esteem
Apathy
Rigidity
Disorientation
Perfectionism
Minimization
Preoccupation
with trauma
Thoughts of
self-harm or
harm to
others
Powerlessnes
s
Anxiety
Guilt
Anger/rage
Survivor guilt
Shutdown
Numbness
Fear
Helplessness
Sadness
Depression
Emotional
roller coaster
Depleted
Overly
sensitive
Impatient
Irritable
Withdrawn
Moody
Regression
Sleep
disturbance
Nightmares
Appetite
changes
Hypervigilant
Elevated
Startle
response
Accident
proneness
Losing things
Questioning
the meaning
of life
Loss of
purpose
Lack of self
satisfaction
Pervasive
hopelessness
Anger at God
Questioning
of prior
Religious
beliefs
Loss of faith
in a higher
power
Greater
skepticism
about religion
Withdrawal
Decreased
interest in
intimacy or
sex
Mistrust
Isolation from
others
Over
protection as
a parent
Projection of
anger or
blame
Intolerance
Loneliness
Increased
interpersonal
conflicts
Shock
Sweating
Rapid
heartbeat
Breathing
difficulties
Aches and
pains
Dizziness
Increased
number and
intensity of
medical
maladies
Sleep
Disruption
Other somatic
complaints
Impaired
immune
system
Low morale
Low
motivation
Avoiding
tasks
Obsession
about details
Apathy
Negativity
Lack of
appreciation
Detachment
Poor work
Staff conflicts
Absenteeism
Exhaustion
Irritability
Withdrawal
from
colleagues
Prevention
Early Recognition and Awareness is
Key!
Restore a healthy balance in your life
including:
Good sleep, good nutrition and exercise
Take Time Off From Work (minivacations)
Enhancing Your Skills by Attending
Stress Reduction Courses
Enhanced Self Care Skills
Don’t Wear This Button
Resiliency: The Ability to Keep On Going
When the Going Gets Tough
Must be well rested
Resiliency sags when you are tired
Utilize your positive supportive
connections to process your feelings
Take negatives and turn them into
positives
Research shows those who can “turn
off thoughts about work” are more
resilient during their careers
Stay Resilient
You need to have good support
You need to have the ability to talk
about it
Be able to disconnect work and home
Strong connections with others
Overcoming Compassion Fatigue
PHYSICAL NEEDS:
Get medical treatment for those
symptoms that are interfering with your
daily functioning;
Eat meals at a relaxed pace
Develop and stick to an exercise plan
Don’t self-medicate with alcohol or drugs
Take time off!
Take time off!
Overcoming Compassion Fatigue
PHYSICAL (cont)
Practice breathing exercises
Breathe deeply: inhale, exhale
Imagine: go to your quiet place
Feel: tension leave, relaxation, healing
come
Overcoming Compassion Fatigue
MENTAL NEEDS:
Assess what’s on your plate. Make a list
of your stressors to see what is making
your plate too full.
Reduce or eliminate multi-tasking.
Identify stressful thinking (e.g. “always,”
“never” “should” “ought”
Reframe failures as mistakes
Overcoming Compassion Fatigue
MENTAL NEEDS (cont)
Notice the connection between thoughts,
feelings and behaviors
Overcoming Compassion Fatigue
A PERSISTENT THOUGHT IS LIKE A DROP OF DYE
IN A BOWL OF WATER: IT COLORS YOUR
PERCEPTION OF THINGS!
(Endicott, Larry)
Overcoming Compassion Fatigue
WORK:
Rebalance your workload! Do you work
through lunch? Spend weekends
catching up?
Take mini-breaks
Do at least one nourishing activity a day
Ask for help
Have a transition from work to home
Overcoming Compassion Fatigue
WORK (cont)
Learn to say “no” more often.
Assess your trauma inputs and create a
visualization or trauma filter to protect
yourself from extraneous material.
Overcoming Compassion Fatigue
WORK (cont)
Create and/or enforce time off policies
in the workplace! A dry well cannot
quench thirst!
Overcoming Compassion Fatigue
RELATIONAL/EMOTIONAL
Create a self-care idea collection such
as a walk on the beach, massage,
watching sports on TV)
Plan time to connect with family and
friends
Keep a feeling journal
Have one good conversation a day
Overcoming Compassion Fatigue
SPIRITUAL
“You are not made for the Sabbath; the
Sabbath is made for you.” (Mark 2:27)
“Sabbath is not dependent upon our
readiness to stop. We do not stop when we
are finished. We stop because it is time to
stop.” (Muller, p 82)
Overcoming Compassion Fatigue
SPIRITUAL (cont)
Prayer & Meditation
Walk the Labyrinth
Be still
Be silent
Listen to music
Read
Overcoming Compassion Fatigue
“Just as speech without silence creates
noise, charity without rest creates
suffering.” (Muller, p. 159)
Overcoming Compassion Fatigue
From Isaiah 40: (paraphrase)
God, the Creator of the
ends of the earth does not
become weary or tired.
God gives strength to the weary and to
whoever lacks might, God increases
power.
All in all
Unrecognized and Untreated
Compassion Fatigue causes people
to
Leave Their Professions
Self Treat with Drugs or Alcohol
Become Suicidal or Self Destructive
Therefore, remember…
You are not God.
The need will always be greater than
the resources.
Use care in how your measure
success
Who you are is as important to the
mission as what you do.
And this…
Their pain is not your pain.
Don’t take them home with you.
Care for your spirit, emotions, and
body so that there will be something
left to give.
(Wood, Samuel)
Be Sabbath for One Another
We can make our minds so like still water
that beings gather about us, that they may
see their own images, and so live for a
moment with a clearer, perhaps even a
fiercer life, because of our quiet. (Yeats)
Questions?
References
Figley, C. (1995). Compassion Fatigue:
Coping with secondary traumatic
stress disorder in those who treat the
traumatized. London: BrunnerRoutledge.
Muller, W. (1999). Sabbath: Restoring
the sacred rhythm of rest. NY:
Bantam.
Power point slides based on work by Larry Endicott, Sue Philpot, Samuel Wood)