"empathic discernment " by dr. charles figley

Empathic Discernment:

The Key to Preventing Compassion FatigueCharles R. Figley, Ph.D.Professor and the Henry Kurzweg, MD Chair in Disaster Mental HealthTulane University School of Social Work, New Orleans, USA

Purpose:

Recognize and avoid the Compassion Fatigue and promote resilienceCaring as much for ourselves as we care for the traumatizedAppreciate the importance of empathic discernment for both.

Objectives:1. Appreciate the various sources of stress among

counselors including the demand to be compassionate with suffering clients – especially fellow survivors of Katrina.

2. Define the critical concepts, including empathic discernment.

3. Describe two useful models for predicting compassion fatigue and the role of empathic discernment.

4. Note the various ways counselors cope with these demands – effectively and ineffectively.

5. Be better prepared to prevent and be resilient in a post-Katrina work environment.

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Basic Caregiver Resilience Assumptions1. Working with the suffering requires

compassion2. Compassion requires empathy, interest,

and contact3. Exposure to clients’ distress can be

distressing for the caregiver, particularly if the distress is associated with the counselor’s own experiences.

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Basic Assumptions (cont.)4. Exposure can also be inspiring. The

services provided generate a sense of pride and satisfaction.

5. Most counselors have the ability to survive, be resilient, and thrive

6. Resilience is the antidote to compassion fatigue.

Definitions of Critical Concepts

Work-related stress: The demands of one’s job that are applied in the work setting but affect other settings as well.Caregiver Resilience: The tendency to cope with the work-related stress naturally or through the help of others (organization and or colleagues, friends, and family

Psychological Burnout:the experience of long-term exhaustion and diminished interest in one’s work that is most often corrected by changing work settings or clients (Altman & Jackson, 2005).

Compassion stress

The perceived demands derived from experiencing the suffering of others and wanting to help relieve their suffering in some way (Figley, 1995; 2002)

Compassion Satisfaction

The perceived joys derived from experiencing the suffering of others and succeeding in helping to relieve their suffering in some way (Figley, 2002)

Empathic Discernment

Effectiveness in accurately selecting and using the best empathic response for both client and self (Radey & Figley, 2007)

Compassion Fatigue (CF) is

the experience of short-term exhaustion and traumatic stress reactions associated with exposure to the suffering one’s clients (Boscarino, Figley & Adams, 2004).

Plain old job burnout stems from dissatisfaction with the work environment

compassion fatigue stems from absorbing the suffering of clients

Vs

Empathic Discernmentis the key ingredient for

Avoiding both burnout and compassion fatigueA case example: Animal caregivers

Humane Society of the US

Organization dedicated to helping and managing abused, neglected, and abandoned animalsMembers of the animal care community include those who rescue animals, care for their medical and psychological needs, or who must euthanize them.Here is a short film about compassion fatigue

Compassion Fatigue Research

Example of the Animal Care Community research (2003-2006)Resulting in a book and a short film

National sample of animal care workers (Roop & Figley, 2006) (cont.)

Compassion Fatigue risk53.1% extremely high risk12.4% high risk11.9 %moderate risk

Burnout risk45.6% extremely low 35.9% moderate risk

Compassion Satisfaction43.0% good21.4% high3.9% extremely high

CF Theory: Based on more than 10 years of research

The following 11-factor model identifies the major factors contributing to compassion stress, fatigue, and management.

The Compassion Fatigue Process:

The Compassion Fatigue Process (Figley, 2001)

..

.

10

Other LifeDemands

Concern

Sense ofSatisfaction

Exposure to Suffering

Detachment

CompassionFatigue

Prolonged Exposureto Suffering

Traumatic Memories

9

1

3

2

5

4

6

7

8

ResidualCompassion

Stress

EmpathicAbility

EmpathicResponse

Implications

1. Compassion fatigue hurts counselors of the suffering2. Compassion fatigue blues can be avoided or stopped3. The way to do it is focusing on EMPATHIC DISCERNMENT

Figure 1: Transformation to compassion fatigue or compassion satisfaction: ROLE OF POSITIVE AFFECT (Radey & Figley, 2007)

CompassionSatisfaction

CompassionFatigue

Direct Practice with the Suffering

Level ofEmpathic

Discernment

Affect Self-care

Resources

(Positive) Affect

Provides essential foundation in meeting client needs (e.g., empathic response, therapeutic alliance) as well as the caregiver needs (e.g., joy of service and its appreciation by all).

Figure 2: Transformation to compassion fatigue or compassion satisfaction: SELF CARE!

CompassionSatisfaction

CompassionFatigue

Direct Practice with the Suffering

Level ofEmpathic

Discernment

Affect Self-care

Resources

Self-careSelf-care involves

Self-monitoringSocial supportive monitoringUtilizing an individually-designed and updated self-care planFollowing recognized standards of self-care

Self-care (cont.)

The negative consequences of poor self-care:Harm to clientsLowered compassion satisfactionHarm to the caregiver’s health and relationships

Figure 2: Transformation to compassion fatigue or compassion satisfaction: Increasing RESOURCES (Radey & Figley, 2007)

CompassionSatisfaction

CompassionFatigue

Direct Practice with the Suffering

Level ofEmpathic

Discernment

Affect Self-care

Resources

Resources ARE IMPORTANT

They include Intellectual, unit morale, effective leadership, and physical resources Intellectual resources includes helping and other practice skills

Resources (cont.)

Physical Resources fromEnhanced recreational resourcesOpportunities to exercise Good nutrition through the cafeteriaContact with nature Personal space and opportunities to use it

Figure 2: Transformation to compassion fatigue or compassion satisfaction: EMPATHIC DISCERNMENT (Radey & Figley, 2007)

CompassionSatisfaction

CompassionFatigue

Direct Practice with the Suffering

Level ofEmpathic

Discernment

Affect Self-care

Resources

Empathic Discernment

Helps in balancing and increasing three independent factors in the process of human services with the suffering: Resources, Affect, and Self-care (RAS)

It is the gateway to determining how much fatigue and satisfaction can be derived from the work of caregiving

Thus, empathic discernment ultimate is a measure of caregiver resilience

Stress Management Strategies for Enhancing Empathic Discernment

Stress Management Resiliency

In vivo (working with clients)Breath-workSelf-talkPhysical movement (walking, bikes, basketball, etc.)

Stress Management Resiliency (cont.)

Between Clients at Work Breathing Meditation Prayer and Meditation Visualization (e.g., safe place) Dance and Other Kinesthetic Treatments

Stress Management Resiliency (cont.)

Journaling Art Therapy Music Therapy Poetry Therapy All hobbies and absorbing activities Music and Other Creative Therapies

Treating Compassion Fatigue

Caregivers deserve as good a treatment as they are providing.Most treatments of anxiety disorders are relevant for CFThe challenge is establishing and maintaining a strong therapeutic alliance with the caregiver client

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Treatment Implications

Focusing on Desensitization of the traumatized worker

Assessment of currently available approaches

Conclusions

1. You deserve as good a treatment as you provide the traumatized2. Caring for yourself results in being a more effective counselor,Family member and friend, andHuman being

Questions, Answers, Discussion

Contact information:CharlesFigley.ComFigley@tulane.edu