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Removing the Cape: Self‐Care &Vicarious
Traumatization
Samantha Nagy, LPC, CCTP, CADC, NCC
Philadelphia College of Osteopathic Medicine
Philadelphia, PA
WAYNE ROFFER, PSYD
LEBANON VAMEDICAL CENTER
LEBANON, PA
Disclaimer
Dr. Roffer, as an employee of the Department of Veterans Affairs, has not been asked to speak today on their behalf or on the behalf of any other federal agency.
The information presented and discussed herein is the personal opinion of Dr. Roffer and Ms. Nagy, and is not to be considered an official policy, statement, or position of any educational institution, Department of Veterans Affairs, other federal agency, or the United States government
Disclosure
Disclosure: Samantha Nagy, LPC, CCTP, CADC, NCC
Wayne Roffer, PsyD
With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (and/or spouse/partner) and any for‐profit company in the past 24 months which could be considered a conflict of interest.
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Objectives
1. Identify elements and the presence of vicarious traumatization
2. Identify internal and external barriers to self‐care and strategies to mitigate the impact of such obstacles on our lives
3. Possess knowledge regarding burnout
4. Assess current self‐care practices and demonstrate self‐care strategies.
My Story
In dealing with those who are undergoing great suffering, if you feel "burnout" setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long‐term perspective.
DALAI LAMA
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Experiential Exercise 1 –Individual
Professional Quality of Life Scale (ProQOL)
https://www.ptsd.va.gov/professional/treat/care/toolkits/provider/selfAssessment.asp
What’s in a Name?
Compassion Fatigue
Burnout
Vicarious Traumatization
Compassion Fatigue• Erosion of our ability to tolerate strong emotions stemming
from listening to the narratives of others
Burnout• Physical and emotional exhaustion as a result of prolonged stress and frustration
• Depleted ability to cope with work and life demands• Sense of powerlessness
Vicarious Traumatization• Repeated exposure to difficult narratives changes our world view
• Nightmares, Intrusive images
• Preoccupation with a story or event
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Big B vs. little b
• burn‐out • Feeling fried at the end of a long day
• “quick fix”
• Burn‐out• Excessive, long standing physical and emotional fatigue
• Concentrated effort to fix
History of Burn‐out
• Psychologist, Herbert Freudenberger (1974)• loss of motivation• growing sense of emotional depletion • cynicism
• Christina Maslach (1976) • Maslach Burn‐out Inventory (1981) • “outstrips a person’s ability to cope with stress” • 6 key component of workplace environment
• Workload• Control• Reward• Community • Fairness • Values
Public Health Crisis
• Burn‐out physicians cost the economy $4.6 billion a year
• Deadlines, demands, working hours, stressors > rewards, recognition and relaxation (WHO)
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Burn‐out as a Diagnosis
• Burn‐out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:• feelings of energy depletion or exhaustion • increased mental distance from one’s job, or feeling or negativism or
cynicism related to one’s job• reduced professional efficacy
• Burn‐out refers specifically to a phenomena in the occupational context and should not be applied to describe experiences in other areas of life
National Center for Health Statistics, April 2019
Compassion Fatigue
• Directly resulting from the continuous act of helping people or animals who are in distress
• Identification with the helpless, suffering or traumatized
• Taught from a young age to help others before ourselves
• Emotional overload • Erosion of ability to tolerate strong emotions and narratives of others
• Exists on a continuum
Compassion Fatigue Symptoms
• Mirror neurons (pick up emotion of person across from you)
• Balance easily upset (sensitive) between acting as a provider vs friend
• Symptoms include: • Excessive blaming • Bottled up emotions • Apathy, sadness • Difficulty concentrating • Preoccupation
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Vicarious Traumatization
• State of tension
• Preoccupation with the traumatic stories of patients/clients
• Impacts world view
Vicarious Traumatization Symptoms
• Unable to get images or descriptions out of your head
• Nightmares, flashbacks
• Hypervigilance
• Restless
• Avoidance
• Change in worldview
How does this impact us?
• Depression
• Needing our own therapy
• Suicidal thoughts
• Divorce
• Health problems
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Macro vs. Micro Self‐Care
• Macro• Vacation
• Exercise
• Diets
• Micro • Meditation
• Strong boundaries
• Personal support systems
Ethics of Self‐Care • Beneficence and Nonmaleficence
• “…strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.”
• 2.06 Personal Problems and Conflicts
• Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work‐related activities in a competent manner
• When psychologists become aware of personal problems that may interfere with their performing work‐related duties adequately, they take appropriate measures, such ass obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work‐related duties
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Experiential Exercise 2 – Group
Break
Experiential Exercise
Discussion
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Self Care & Resource Development
Reboot & Rebalance
DelegateSet
BoundariesDon’t go it
alone
Self‐InventoryCaroleann MacWhirter
Implementing Self‐Care Strategies
• Daily Changes • Home
• Work
• Specific Plans • What – when – why
• Keep in mind Macro and Micro changes
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Self‐Care Examples
• Mantras• Doorknob Affirmations
• I Surrender Jar
• ABC • Awareness – breath – core
• Empty Coat sleeves
• Marching Orders
• Doodles• BE CAREFUL
Resource Development: mHealth
• Insight Timer
• Breathe2Relax
• Mindfulness Coach
• Tactical Breather
• Provider Resilience
• Relax with Andrew Johnson (lite)
• Headspace.com
• Mindful.org
Insight Timer
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Provider Resilience
Experiential Exercise 3
Commitment to Change
References:• https://www.apa.org/monitor/2008/11/ethics
• http://www.apa.org. (2003). Ethical Principles of Psychologists and Code of Conduct. [online] Available at: http://www.apa.org/ethics/code/
• http://www.compassionfatigue.org/pages/symptoms.html
• http://www.compassionstrengths.com/uploads/Compassion_fatigue_nursing.pdf
• http://www.compassionfatigue.org/pages/RunningOnEmpty.pdf
• https://www.counseling.org/docs/trauma‐disaster/fact‐sheet‐9‐‐‐vicarious‐trauma.pdf
• Sorenson, C., Bolick, B., Wright, K., & Hamilton, R. (2016). Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature. Journal of Nursing Scholarship, 48(5), 456–465. https://doi‐org.ezproxy.pcom.edu/10.1111/jnu.12229
• https://www.ihs.gov/telebehavioral/includes/themes/responsive2017/display_objects/documents/slides/nationalchildandadolescent/vicarioustrauma1116.pdf
• Bush, A. D. (2015). Simple self‐care for therapists: Restorative practices to weave through your workday. New York: W.W. Norton & Company.
• Lipsky, L. V., & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others. Oakland, CA: Berrett‐Koehler.
• Norcross, J. C., & VandenBos, G. R. (2018). Leaving it at the office: A guide to psychotherapist self‐care. New York: The Guilford Press.
• Rothschild, B., & Rand, M. L. (2006). Help for the helper: The psychophysiology of compassion fatigue and vicarious trauma. New York: W.W. Norton.
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