compassion fatigue/ secondary traumatic stress: caring for the caregivers

Compassion Fatigue/ Compassion Fatigue/ Secondary Traumatic Stress: Secondary Traumatic Stress: Caring for the Caregivers Caring for the Caregivers

Together We CanApril Naturale, MSW, Ph.D.

Lafayette, LAOctober 6, 2010

Goals and ObjectivesGoals and ObjectivesGoal:For staff working with abused and traumatized children to understand and address their risks and responses to Compassion Fatigue, Secondary Traumatic Stress and BurnoutObjectives: • To be able to identify the body and mind’s responses to stress• To learn ways mitigate and address these responses by implementing skills and self care• To monitor changes over time

Stress is a cognitive reaction that affects humans physiologically

Individuals from different backgrounds, cultures and geographic areas perceive

stress differently

CONCEPTS OF STRESS VARYCONCEPTS OF STRESS VARY

The Physiology of StressThe Physiology of Stress

Good Stress The good stress allows us to perform at a

higher level (fight or flight)

The production of cortisol improves memory and enhances immune function

Spikes in blood pressure flood our muscles and brain with oxygen

The Physiology of StressThe Physiology of Stress

Bad Stress-Overload

The allostatic system becomes charged too frequently with NO CHANCE TO VENT the build up of energy

Too much cortisol will damage memory, hurt or weaken your immune system and enlarge your stomach

Work StressWork Stress

Stress measured by increases in blood pressure is generally twice as high during the work day compared to when at home or time off.(Pickering, 2005)

Work Stress Work Stress

The worst work-related stress is caused by jobs where people have little

control over activities and the rate at which they have to address

them

Environmental EffectsEnvironmental Effects

Responsibility of caring for physically and/or emotionally abused, neglected children

Exposure to the fear, grief, pain, loss, separation, death of children

The community/social response (or lack of)

Additional FactorsAdditional Factors Depression-5-10% of the population (NIMH, 2005)

Race-genetics, family illnesses

Diet –high salt, high fat

Social Constructs-professional women, single parents with children

Children react to caregiver’s emotional responses

Child care workers put needs of children ahead of their own

Increased responsibility of caring for children increases the stress response

The Population of CareThe Population of Care

Compassion FatigueCompassion Fatigue

THE COST OF CARING

Secondary Traumatic Secondary Traumatic StressStress

The experience of trauma symptoms in the counselors as a result of

listening to the trauma material of clients

DifferentiationsDifferentiationsNot burnout, but can lead there (Figley, 2002)

Unlike countertransference (Green, 1992)

Differentiated from vicarious trauma (Pearlman &

Saakvitne, 1995; Figley, 1999)

Compassion fatigue and secondary traumatic stress are most similar in meaning (Stamm 1999)

Symptoms (Trauma Symptoms (Trauma Specific)Specific)

High adrenaline, physical euphoria, numbness-the endorphin effect disguises distress

Coupled with fatigue, cognition can change and create an inability to recognize poor judgment

Anger is a common defense against recognizing the problem

SymptomsSymptomsPosttraumatic stress disorder symptoms;

Symptoms that parallel those of client Monroe, 1999

Negative cognitive schemas Pearlman & Saakvitne, 1995)

Questioning beliefs; Sense of helplessness

Isolation; Depression; Increased substance use; Increased rates of physical illness

Lower staff morale and productivity; Higher turnover and errors Stamm, 1997

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Medicating or narcotizingOvereating, excessive drinkingExtramarital affairsSuicidal gestures

High Risk SymptomsHigh Risk Symptoms

Tiredness/weariness yet insomnia

Brooding, wistful, mournful-Depressive

Increasing demoralization

Intellectualizing/Religionizing the work

Grandiosity (I can handle this myself/don’t consider asking for help)

Long Term Exposure SymptomsLong Term Exposure Symptoms

Risk CategoriesRisk Categories Health, mental health, social services

providers

Staffs with clients who experience profound suffering

Highly exposed response staffs (media, clergy, caregivers)

Inhibited individuals in these groups (more likely to have dissociative responses)

Risk VariablesRisk VariablesLesser educated and lesser

experienced counselors

Greater length of assignment results in higher STS risk

Gender and ethnicity have been found to affect STS (women and minority status)

Child Care WorkersChild Care WorkersAre generally self sacrificing -many place themselves in danger -many will work ‘till it hurts -many will skip breaks -many will ignore/fight direction to rotate assignments, go off duty or take benefit time even when encouraged

Automatic ResponsesAutomatic Responses

Caregivers react to stressful situations by training- without the benefit of thought-they go right to caring for others

Concerns for family don’t disappear-We put our own emotions on hold

Cognitive reactions reinforce physical reactions (our thinking controls our actions)

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What Can You Do?What Can You Do?

LearnBe AwareMonitorThinkPracticeChangeManage

Prevention: StructuralPrevention: Structural

Vary caseload of trauma and non trauma cases

Utilize buddy system

Access supervision routinely

(Dugall, Herberman, Delahanty, Inslicht & Baum, 2000).

Supervisors-mandate case rotation and use of benefit time (Monroe, 1999)

• Expect, seek & accept peer

support

• Master controlled, limited

empathy• Define structure and boundaries

• Monitor overidentification

• Self assess-PRO QUAL-IV

• Commit to implementing self-care

Prevention: Professional PerspectivePrevention: Professional Perspective

Recognize when you are: Hungry Angry Lonely Tired Maintain support systems

Schedule personal time, engage in pleasurable activities

Maintain a balance

Practice Self Care

Prevention: PersonalPrevention: Personal

Prevention: Professional Prevention: Professional PerspectivePerspective

Be realistic

Commit to implementing self-care

Recognize that the world won’t fall apart without you

LET GO

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• Give yourselves permission to celebrate even in the midst enormous stress- play, laugh, experience joy

• Be together-don’t isolate

• Communicate, communicate, communicate (e.g. I need you to understand, we will get through this together, let’s stay connected)

• Plan for every day

As a UnitAs a Unit

Managers, Professionals and Front Line staff can mitigate compassion fatigue and burnout by using stress management techniques. Learn those personally effective ways of using relaxation: - focused breathing; - distraction; - seek support, comfort from loved ones - use positive self talk

Simple Stress ManagementSimple Stress Management

Breathing, Stretching, Walking

Healthy Diet-Avoid excesses

Body Work Body Work Body Work (Exercise, Yoga, Meditation, Guided Imagery, Self Hypnosis)

Meditation

Music

Physical ToolsPhysical Tools

Start with the Start with the 333 STOP333 STOP MethodMethod

STOP Where You Are3 Minutes3 Breaths

3 Times a day

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Graduate to the Relaxation Response

Cognitive ToolsCognitive Tools

• Interrupt the Automatic Response/Reduce the Reaction

• CBT (Messaging; Thought Stopping/Insertion)

• Emotion Regulation (Turn Down the Vibration)

• Reintroduce Routing-Return to Normal Activity

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AffirmationsAffirmations

Familiarize yourself with the action of affirmations both auditory and visual

Sample different expert’s work-choose voices and images that are pleasant to your eyes/ears

Schedule the use of these tools to obtain maximum benefit

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Leisure Tools Leisure Tools Try Acupuncture, Art, Awareness, Create,

Cook, Dance, Dream, Draw, Exercise, Enjoy, Explore, Go Home, Kick-Box, Laugh, Limit work, Loosen up, Listen to music, Massage, Meditate, Practice Yoga, Paint, Pet the Pet, Sing, Sit Quietly, Sleep, Start a Book, Stretch, Talk to Yourself, Family and Friends, Wade, Walk, Watch a bug, or a movie or the sunset, Whistle, Wish

Do Something other than WORK

Stay focused on answering the question that is being asked.

Read the introductory words and think for a moment how you will respond to the questions by starting with the introductory words.

 1. What problem(s) do this work bring to your life? Begin

your response: “Being a child care worker brings ________________to

my life….” (e.g.: excessive worry ) 2. How has this problem affected your family life or other

relationships? Begin your response:  “This problem, _________________, has affected my life

by…” 3. What have you done to cope with or address this

problem? Begin your response:  “To cope with this problem, I have….”

Publications WebsitePublications Website

National Mental Health Information Ctr

www.mentalhealth.samhsa.gov/cmhs/katrina/pub_respond.aspNational Center for Posttraumatic

Stress Disorder www.ncptsd.org Compassion Satisfaction & Fatigue

Test www.isu.edu/~bhstamm/tests/satfat.htm