•what we learn in school · journal of health psychology (march 2009), 14(2), pg. 267.277. •...

© Françoise Mathieu 2011 1

Françoise Mathieu, M.Ed., CCC.

Compassion Fatigue Solutions Inc.

www.compassionfatigue.ca

Understanding Compassion Fatigue and Vicarious Trauma

•What we learn in school •Background

Prior Training on CF/VT?


Workshop Outline

•  What are Compassion Fatigue/Vicarious Trauma/Burnout? •  Why do they occur? •  Early identification of warning signs/Prevention tools

•  Session Two: •  Self care strategies •  Organizational strategies

Laura Van Dernoot Lipsky

•A deep erosion of our compassion, of our ability to tolerate strong emotions/difficult stories in others

•Evident in helpers’ professional and personal life

•Can also happen to caregivers (“caregiver fatigue”)


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The reality… •Deeply compromised system •Ongoing challenges & cutbacks •Difficult stories •Losses


•Vicarious Traumatization •Compassion Fatigue •Burnout •Moral Distress

A workbook on Vicarious

Traumatization


•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.

“An occupational Hazard”

•  What I wasn’t told during my training…Cambridge •  How it manifests itself: My favourite self care activity:

volunteering at children’s school – A loss of innocence


Discussion: Have you noticed a change in your world view?

Why I started offering these workshops

After 7 years as a crisis worker:

• During the last two years of Crisis counselling - started noticing the following:

•  Very Irritable with colleagues •  Avoiding/skipping staff meetings •  Predictability of clients issues •  Frustration with continually dwindling resources (nowhere to

send them)

Bibliography available


• Leeat Granek et al (2012) Nature and Impact of Grief Over Patient Loss on Oncologists' Personal and Professional Lives Arch Intern Med. 2012;172(12):964-966.

Our grief as professionals: A Taboo subject

“The reality is that we don’t teach doctors how to cope with the death of their patients,” Dr. Derek Puddester, University of Ottawa Faculty of Medicine Wellness Program.

Source www.healthzone.ca/health/articlePrint/1203206 Image: Guido Scarabottolo NY Times.

Our grief as professionals: A Taboo subject

•  Grunfeld study (2000) Cancer care workers in Ontario •  physician exhaustion 53.3%

•  Najjar, Nadine, et al. Compassion Fatigue: A review of the Research to date and relevance to Cancer-care providers, Journal of Health Psychology (March 2009), 14(2), pg. 267.277.

•  " Fifty-seven studies were reviewed to identify the prevalence of compassion fatigue among cancer-care providers, instruments used to detect it and means of prevention and treatment. Conclusions were limited by an ambiguous definition of compassion fatigue that fails to adequately differentiate it from related constructs (e.g. burnout, secondary traumatic stress) […]”


•  Emotional exhaustion: 53-69% among oncologists compared to 37.1% among allied health care staff

•  Low personal accomplishment: 1/3 of Canadian gyneco-oncologists. 50% Ontario oncologists "reported feelings of low personal accomplishment”

•  Anxiety, depressive sx: up to 1/3 of oncologists studied

•  From: Kearney, M.K., et al Self-care of physicians caring for patients at the end of life. JAMA, March 18, 2009 - vol 301, no 11.

• Head and neck surgeons - 34% reported feeling burned out • Physician Work Life study: “women were 1.6 times more likely to report burnout than men. The odds increased by 12%-15% for each additional 5 hours worked per week over 40 hours.” • Using a wide range of coping strategies far more effective than using a narrow range or negative coping strategies

Source: Emanuel, L. et al Combating compassion fatigue and burnout in cancer care medscape

•Depending on the studies, 40-85% of helping 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 •Surgeons suicide rate


• ”As compassion fatigue increased, the number of self-care activities that HCPs reported decreased.”

Source: Alkema, Karen, Linton, J.M., Davies, R. A study of the relationship between self-care, compassion satisfaction, compassion fatigue, and burnout among hospice professionals. Journal of social work in end-of-life & palliative care (oct 2008), 4 (2), pg. 101-119.

Recent Data •Family lawyers: Much higher rates of VT than mental health counsellors •59% of mental health workers would be willing to get help as needed vs 15% of police officers

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

•  Feel powerlessness to achieve goals

•  Can happen in any occupation

Small Group Activity: Think about your own work and its

impact on you

What is challenging/difficult about your work?

Client stories Lack of resources Organizational problems Volume of work Etc.

Soldat anonyme, Rwanda, 1994 Photo site web OSSIS

Primary Trauma


•  Post Traumatic Stress Disorder (PTSD) •  As a consequence of the work: eg EMS - car

accidents, fatalities involving children •  From our personal lives, our own past

The work I currently do •  Personal counselling •  Couples counselling •  Workshops/training on CF/VT/Helper self care



Compassion Fatigue

Vicarious Trauma

Burnout

Primary Trauma

First Step: •Understanding what is happening to you: is it CF/VT/MD/Burnout? •Understanding the warning signs •Developing an early intervention plan


ProQol Inventory

•  Testing for CF, burnout and Compassion Satisfaction

“The Thingy”

Email for excel version: [email protected]

3 New Videos

• Low impact debriefing (anti-sliming strategy)


• Low impact debriefing (anti-sliming strategy)

Low Impact Debriefing

1)  Increased Self Awareness

2)  Fair Warning

3) Consent

4) Low Impact Disclosure

Questions to ask yourself before you share graphic details:

Is the listener: •  Aware that you are about to share

graphic details? •  Able to control the flow of what you

are about to share with them? •  Read article on LID:

www.compassionfatigue.ca and clicking on “Resources”


Strategy #2:

Take stock of stressors and self care…Warning signs

Workbook

•  Signs and symptoms checklist

•  Your S&S will be your WARNING SIGNS


• Exhaustion •  Insomnia • Headaches •  Increased susceptibility to illness • Somatization and hypochondria

Mind/Body Medicine Gabor Maté


Increased use of alcohol and drugs

Anger and Irritability

Avoidance of clients

Absenteeism Impaired ability to make decisions

Problems in personal relationships

Attrition Compromised care for clients

Forgetfulness

•  Distancing •  Negative self image •  Depression •  Reduced ability to feel

sympathy and empathy

•  Cynicism •  Resentment

•  Dread of working with certain clients

•  Feeling professional helplessness

•  Depersonalization •  Disruption of world

view

•  Problems with Intimacy

•  Intrusive imagery •  Heightened anxiety or

irrational fears


•  Hypersensitivity to emotionally charged stimuli

•  Insensitivity to emotional material

•  Increased sense of personal vulnerability

•  Loss of hope •  Difficulty separating

personal and professional lives

Sources: Saakvitne, Figley, Gentry, Baranowsky & Dunning (1997).

•  Conceptualizing CF as three zones: green; yellow and red

•  Signs you are in the red zone

•  Signs you are in the yellow zone

Upcoming events

•  Train the Trainer: Two day Retreat. Kingston, March 2012.


Upcoming events

•  Vicarious Trauma Conference, Los Angeles, Nov 8-9th, 2012. CII

•  The Annual Compassion Fatigue Conference Kingston, June 2013. www.cfconference.com


[email protected]

For More Resources/Information

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