Compassion Fatigue
Presented by:
Jim Messina, Ph.D.
Licensed Psychologist
Lead Disaster Mental Health Services
Tampa Bay Chapter of American Red Cross
Psychologist with: St. Joseph’s Hospital, Vericare, Argosy University
Presentation Available on: www.jamesjmessina.com
"The pessimist complains about the wind;
The optimist expects it to change;
The realist adjusts the sails."
William Arthur Ward
Goals for Our Program
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Identify the signs and symptoms of
Compassion Fatigue
Identify strategies for the prevention of
Compassion Fatigue
Problem solve solutions for recovering
from or dealing with acute Compassion
Fatigue
What is
Compassion Fatigue (CF)?
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Compassion fatigue is thought to be a
combination of secondary traumatization
and burnout precipitated by the care
delivery that brings health-care
professionals into contact with the
suffering
Szabo, B. (2006). Compassion fatigue and nursing work: Can we
accurately capture the consequences of caring work? International
Journal of Nursing Practice: 12: 136–142.
Difference between
CF and Burnout
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"Compassion fatigue is when caregivers have such deep
empathy they develop symptoms of trauma similar to the
patient” according to director of the Army Institute of
Surgical Research Col Kathryn Gaylord
The disorder can also resemble burn out which occurs
when emotional exhaustion is experienced due to
increased workload & institutional stress & does not
involve trauma
Compassion fatigue can have detrimental effects on
doctor patient relationships since doctors suffering from
the disorder often either grow distant from patients or get
too close
Wilson, E. (2008). New Program Offers Care for Caregivers.
Department of Defense Military Health System News, 23 May 2008.
Secondary Traumatic Stress
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People who come into continued, close contact
with trauma survivors may also experience
emotional disruption, becoming indirect victims of
the trauma
The natural, consequent behaviors & emotions
resulting from knowledge about a traumatizing
event experienced by a significant other
The stress resulting from helping or wanting to
help a traumatized or suffering person
Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among
Social Workers. Social Work: 51(2): 63-70.
Compassion Satisfaction
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Compassion satisfaction is the ability for clinicians
to derive a great sense of meaning & purpose from
their work
It may aid in alleviating existential terror endemic
to the human condition when a society is at war
It may be an important buffer in managing and
transcending alterations in belief systems, and
physiological or emotional reactions seen in
compassion fatigue
Stamm (1999 and 2002) as quoted in: Tyson, J. (2007). Compassion
Fatigue in the Treatment of Combat-Related Trauma During Wartime.
Clinical Social Work Journal; 35:183–192
Major factors contributing to
CF
4.
Poor self-care
Previous unresolved trauma
Inability or refusal to control work
stressors
Lack of satisfaction for the work
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Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with
1.
2.
3.
secondary traumatic stress disorder in those who treat the
traumatized. New York: Brunner/Mazel.
Predictors of CF among
Hospice Nurses
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2.
3.
4.
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Trauma
Anxiety
Life demands
Excessive empathy (leading to blurred
professional boundaries)
Abendroth, M. & Flannery, J. (2006). Predicting the Risk of
Compassion Fatigue: A Study of Hospice Nurses. Journal of
Hospice and Palliative Nursing: 8(6): 346-356.
Reason for Our Focus on CF
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It is imperative that clinicians take steps to
ensure that they are functioning at their
best in the therapeutic relationship
Facilitating their own personal well–being
and avoiding burnout is clearly one way in
which this can be achieved
Linley, P.A. & Joseph, S. (2007). Therapy work and therapists’ positive
and negative well-being. Journal of Social and Clinical Psychology:
26(3):385–403.
Self-Assessment
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Take the Compassion Self-Assessment
Rate each item on a scale from 1 to 10
 1 = never experienced
 5 = occasionally experienced
 10 = frequently experienced
What does this Assessment
Tell You?
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If you rated three or more items over 8
or if you rated 5-10 over 5
You are most likely experiencing some
level of compassion fatigue already
Characteristics of clinicians
experiencing compassion fatigue
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Physically: Chronic sense of exhaustion and fatigue, insomnia,
headaches, stomachaches, lack of appetite, physical agitation or
retardation, frequent bouts of sickness (e.g., colds, sore throats)
Psychologically: often feel irritable, are overwhelmed by the volume
and content of their work
Relationship with Clients: sense a reduction in their baseline
empathy for others, feel numb to patients’ and families’ pain, are
cynical regarding clients’ ability to change and/or perceive them as
being responsible for many of their problems
Organizationally: often report a sense of feeling scattered and
unable to meet their professional & personal obligations
Mendenhall, T. (2006). Trauma-Response Teams: Inherent Challenges
and Practical Strategies in Interdisciplinary Fieldwork. Families
Systems, & Health: 24(3):357-362.
So Why Assess for CF
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It is expected that most clinicians will at times
experience symptoms of compassion fatigue, as
these are normal reactions to trauma work.
However, for some clinicians the experience of
compassion fatigue may become so severe as to
interfere with their clinical effectiveness and their
personal mental health.
It is for this reason that ongoing monitoring is
necessary.
Bride, B., Radey, M. & Figley, C.R. (2007). Measuring Compassion
Fatigue. Clinical Social Work Journal: 35:155-163.
Early Assessment Impact
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Instead of waiting for the clinicians to become symptomatic
use inventory tools to look for the presence of challenges
to their fundamental assumptions, values & beliefs
With early assessment clinicians have the opportunity to
transform their discomfort into personal growth &
development
This should be the aim of a professional supervision and
support model to address CF
Tehrani, N. (2007). The cost of caring – the impact of secondary
trauma on assumptions, values and beliefs. Counselling Psychology
Quarterly: 20(4): 325–339.
So What Does One Do to
Overcome Compassion Fatigue?
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Please break up into teams of 3-5
member to brainstorm 3 ideas to help
individuals overcome or prevent
compassion fatigue in their lives
OK let’s go!
What You Can Do!
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Recognize the symptoms of compassion fatigue
Learn to ask for help
Be aware and accept the limitations of your family, your job, and
yourself
Maintain discipline in daily responsibilities and duties
Take “time out” during the day
Take short vacations at least twice a year
Try to change little things that gnaw at you and accommodate to those
you can't change
Organize your time so you can concentrate on vital tasks
Admit compassion fatigue is a real problem for you and don't try to
cover it up
Distinguish between stressful aspects of your job or home life that you
can change, and those you can't change-change what you can
What clinicians need to ward
off CF
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Boundary maintenance
Self-care
Good training
Good supervision
If given all 4 clinicians will thrive as
compassionate professionals
Radey, M. & Figley, C.R. (2007). The Social Psychology of
Compassion. Clinical Social Work: 35(1):207–214
So What Can Be Done On the Job
to Lessen Compassion Fatigue?
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In your teams brainstorm three things
which can be done on the job to lessen
or prevent the impact of Compassion
Fatigue!
Ok Let’s Go!
What can be done on the job!
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Identify realistic attainable goals for each department and evaluate
accordingly
Help staff to maintain personal growth both at home and on the job
Encourage and support staff to develop an active outside life with a
variety of interests
Encourage staff to personalize the work environment with meaningful
pictures, objects, colors, etc.
Encourage staff to be comfortable with themselves by setting limits how
far to become involved with clients and colleagues
Encourage and practice good communication skills on the job
Provide for flexible working conditions on the job
Encourage trying new ideas “outside of the box”
Sponsor “decompression techniques” activities such as meditation or
exercise that relieve tension and put staff into a more relaxed state
Build support systems among staff to discuss problems and help each
other look for solutions. Don't just air gripes - look for solutions
What one group is doing:
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This program offered staff a safe place, among
colleagues to discuss their recent feelings and destress
Participants were provided services such as yoga,
meditation and therapeutic massage
All staff completed a Compassion Fatigue Survey
All staff were treated with a 45 minute
therapeutic massage
Politsky, S. (2007) Revitalizing Yourself. Oncology Nursing Forum:
34(2): 494.
Training like this helps!!!
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Sprang et al, found that specialized trauma training
did enhance Compassion Satisfaction and reduced
levels of Compassion Fatigue and Burnout,
suggesting that knowledge and training might
provide some protection against the deleterious
effects of trauma exposure
Sprang, G., Clark, J. & Whitt-Woosley, A. (2007). Compassion Fatigue,
Compassion Satisfaction, and Burnout: Factors Impacting A
Professional’s Quality of Life. Journal of Law and Trauma, 12:259–280.
So there you have IT!
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Dealing with Compassion Fatigue is a
TEAM effort which requires administration,
co-workers, your families and significant
others to understand that it takes a lot of
effort to prevent and deal with this
insidious and disabling condition!
Best of Luck!