Addressing Compassion Fatigue in Helping Professions

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Managing Compassion Fatigue,
Vicarious Trauma and Burnout in
the CIT Responder
Michelle S. Albert, LPC, CSOTP
  
Andrea Shea, LPC
Jail Diversion Supervisor
   
Emergency Services Supervisor
Alexandria CSB
    
Prince William CSB
Virginia CIT Conference October 16, 2018
Exercise: Life / Work Balance
 
Were the areas in which you score high what you
predicted they would be?
Are there things in your life draining you that you
didn’t suspect or realize?
When is the last time you gave careful thought to
specific things that drain you?
Do you engage in healthy self-care practices?
Do you practice self-validated caregiving? Is your
self-care guilt-free?
 
 
“The expectation that we can be immersed in suffering
and loss daily and not be touched by it is as unrealistic
as expecting to be able to walk through water without
getting wet.”
   
Kitchen Table Wisdom (1996)
   
Rachel Naomi Remen
Objectives
 
Develop a framework for understanding and
differentiating between:
Moral Distress
Vicarious Trauma
Burnout
Compassion Fatigue
Normalize the “helper experience”
Self-Assessment / Awareness
Self-Care and Resilience Strategies
Have Fun!
First World Problems
https://www.youtube.com/watch?v=vN2WzQzxuoA
The Reality of Helping Professions
 
Compromised or inflexible systems (i.e. schedules,
lack of staff, lack of training, poor work
space/environment)
Systemic challenges and budget cuts
Difficult stories and situations of those you help
Losses
Disclaimer – own experiences
Moral Distress
 
An issue that affects all helping professions
Involves a threat to one’s moral integrity – that sense
of wholeness and self-worth that comes from having
clearly defined values that are congruent with one’s
perceptions and actions
A Helper may experience Moral Distress or Moral
Injury multiple times per day or shift
“When policies or routines conflict…with
beliefs…about patient care” (Mitchell 2000)
Trauma
 
“Primary” trauma – A trauma experienced in the first-
person. Professional or personal - Many people in the
helping profession have experienced multiple personal
traumas. It’s part of what makes us good at our jobs!
 
Secondary or “Vicarious” Trauma – A trauma that is
experienced second-hand, in the re-telling of events,
investigations, observations
 
Tertiary Trauma – Long-range effects of a traumatic
incident or pervasive environmental conditions
 
    Which of these three is most damaging?
Vicarious Trauma (VT)
 
Occurs when the stories we hear from people transfer
onto us in a way where we are secondarily traumatized
and have difficulty ridding ourselves of the images and
experiences they have shared
 
The profound shift Helpers experience in their world
view when they work with people who have experienced
trauma
 
Fundamental beliefs about the world are altered and
possibly damaged by being repeatedly exposed to
traumatic material
 
COACH
Burnout
 
Does not mean our world view has been changed
 
Gradual onset of dissatisfaction and resentment with the work
environment
 
The exhaustion and disconnect employees can experience
when job satisfaction is low and they feel powerless and
overwhelmed
Directly related to the work environment – hours, supervisors, training, etc.
Depleted ability to cope with work demands
Feel powerless to achieve goals
 
Specific to the work environment, Burnout is the easiest to fix
Compassion Fatigue (CF)
Characterized by an emotional and physical
exhaustion, a Helper can develop CF over the course
of their career when they are unable to refuel and
regenerate
A deep erosion of our compassion and our ability to
tolerate the strong emotions and difficult stories of
those with whom we work
Stems from absorbing the suffering of others 
(Figley, 2009)
The Compassionate Connection
Risk Factors
 
Intensity
Frequency
Severity
Proximity
Personal Factors
Previous trauma
Anxiety
Depression
Impulsive/High-risk behaviors
Substance use
Where are your Skittles?
 
 
Have you noticed a change in your world view or
have you found that you give the best of yourself at
work and have nothing left when you get home?
Physical Symptoms
 
Shock / Disbelief
Sweating
Rapid heartbeat
Unexplained aches and pains
Dizziness
Impaired immune system
Restlessness
Sleep disturbance
Appetite disturbance
Impact on Professional Functioning
 
     
Performance
Decrease in quality and quantity
  
Low motivation
Avoidance of job tasks
   
Increased mistakes
Setting perfectionist standards
  
Obsessing about details
 
Morale
Decrease in confidence
   
Loss of interest
Dissatisfaction
    
Negative attitude
Apathy
     
Lack of appreciation
Detachment
    
Feelings of incompleteness
 
  
Interpersonal
Withdrawal from colleagues
  
Impatience
Decrease in quality of relationships
  
Poor communication
Staff conflicts
Impact on Personal Functioning
 
Withdrawal from others
Decreased interest in intimacy
Mistrust
Intolerance
Loneliness
Projection of anger or blame
Irritability
Spiritual  Symptoms of Poor Self Care
 
Questioning the meaning of life
Loss of purpose
Lack of self-satisfaction
Pervasive hopelessness
Angry at higher power
Questioning prior beliefs
 
Do 
these
 symptoms leave you feeling like…
 
THIS
??
Protective Factors
 
Support system
Part-time work or other tasks
Adequate training
Work-Life balance
Belief system
Current coping strategies
Implementation of self-care techniques
Ability to recognize warning signs
My Colleagues are Awful!
 
Many Helpers find the negativity of their colleagues
to be a big challenge
 
Reframe this negativity and think of it as an
organizational form of compassion fatigue, caused by
the CF and VT that some of our most depleted
colleagues are experiencing
 
 
What Does Your Dragon Look Like?
Health
Meet the Dragons
 
Key Elements in Review
 
CF/VT can affect an individual or can contaminate
an entire workplace as a whole
 
Not all workplaces are created equal! You could be
experiencing burnout due to an unsupportive
workplace 
in addition 
to CF/VT from the
challenging work you do
Well, That’s Lovely. Now What?
 
 
Awareness is the first step
 
What is affecting you… CF? VT? Burnout? Moral
Distress? A combination of two or more?
 
Understand your 
warning signs
 
What are your “Big Three”?
ABC’s of Prevention and Maintenance
 
 
A
wareness – Recognizing signs and symptoms
B
alance – Taking personal responsibility
C
onnection – Seeking consultation and debriefing
 
 
 
Have you been slimed?
 
 
Debriefing vs. Venting aka “sliming”
 
Self-Awareness
 – Pay attention to how your sharing impacts others;
avoid “sliming”
 
Fair warning
 
Permission to come aboard
Get Control of Yourself
 
 
BREATHE
!!!
Identify the desired outcome
Steps for a desired outcome:
Ask yourself what you want
Identify areas in your life where you 
DO
 have control
Make a plan:
What’s in your Self Care First Aid Kit?  (Your “person”, snacks,
stress ball, comedy, music, exercise, etc.)
4 Domains of Control to Make a Change
 
 
Physical
 
Cognitive / Attitude
 
Existential / Meaning & Purpose
 
Relationships – “No” is 
not
 a four-letter word
When to Seek Outside Help
 
An increase in self-destructive or high-risk behaviors
(alcohol, food, drugs/medications, spending, etc.)
Missing work
Increased irritability
Lack of empathy towards 
everyone
Anxiety
Symptoms of depression
Sleep and/or appetite disturbance
Withdrawing
Anhedonia/Apathy
Healthy Detachment
 
What are you in this for? Are you making it about
you? Are you wanting helping someone else to
provide you with a sense of satisfaction? (e.g. “You’re
OK… then I’m OK”)
 
“It doesn’t mean we don’t care. It means we learn to
love, care and be involved without going crazy.” 
(M.
Beattie, 1992)
 
“When we allow people to be who they are, then we
stop trying to change things we can’t.” 
(M. Beattie, 1992)
Stress Reduction Activity
BANG
HEAD
HERE
Directions
1.
Place on firm, flat surface
2.
Follow directions on circle
3.
Repeat step 2 as necessary or until unconscious
4.
If unconscious, cease stress reduction activity
Guided Meditation
https://vimeo.com/132790897
“I did the best I could with the light I had to see by”
      
- 
Author Unknown
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Explore the challenges faced by helping professionals like moral distress, vicarious trauma, burnout, and compassion fatigue. Learn about self-care strategies, awareness, and resilience to prevent burnout and maintain well-being in demanding roles. The presentation emphasizes the importance of recognizing and addressing the emotional toll of caring for others.

  • Compassion Fatigue
  • Helping Professions
  • Self-Care
  • Burnout
  • Vicarious Trauma

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  1. Managing Compassion Fatigue, Vicarious Trauma and Burnout in the CIT Responder Michelle S. Albert, LPC, CSOTP Jail Diversion Supervisor Alexandria CSB Andrea Shea, LPC Emergency Services Supervisor Prince William CSB Virginia CIT Conference October 16, 2018

  2. Exercise: Life / Work Balance Were the areas in which you score high what you predicted they would be? Are there things in your life draining you that you didn t suspect or realize? When is the last time you gave careful thought to specific things that drain you? Do you engage in healthy self-care practices? Do you practice self-validated caregiving? Is your self-care guilt-free?

  3. The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. Kitchen Table Wisdom (1996) Rachel Naomi Remen

  4. Objectives Develop a framework for understanding and differentiating between: Moral Distress Vicarious Trauma Burnout Compassion Fatigue Normalize the helper experience Self-Assessment / Awareness Self-Care and Resilience Strategies Have Fun!

  5. First World Problems https://www.youtube.com/watch?v=vN2WzQzxuoA

  6. The Reality of Helping Professions Compromised or inflexible systems (i.e. schedules, lack of staff, lack of training, poor work space/environment) Systemic challenges and budget cuts Difficult stories and situations of those you help Losses Disclaimer own experiences

  7. Moral Distress An issue that affects all helping professions Involves a threat to one s moral integrity that sense of wholeness and self-worth that comes from having clearly defined values that are congruent with one s perceptions and actions A Helper may experience Moral Distress or Moral Injury multiple times per day or shift When policies or routines conflict with beliefs about patient care (Mitchell 2000)

  8. Trauma Primary trauma A trauma experienced in the first- person. Professional or personal - Many people in the helping profession have experienced multiple personal traumas. It s part of what makes us good at our jobs! Secondary or Vicarious Trauma A trauma that is experienced second-hand, in the re-telling of events, investigations, observations Tertiary Trauma Long-range effects of a traumatic incident or pervasive environmental conditions Which of these three is most damaging?

  9. Vicarious Trauma (VT) Occurs when the stories we hear from people transfer onto us in a way where we are secondarily traumatized and have difficulty ridding ourselves of the images and experiences they have shared The profound shift Helpers experience in their world view when they work with people who have experienced trauma Fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material

  10. COACH

  11. Burnout Does not mean our world view has been changed Gradual onset of dissatisfaction and resentment with the work environment The exhaustion and disconnect employees can experience when job satisfaction is low and they feel powerless and overwhelmed Directly related to the work environment hours, supervisors, training, etc. Depleted ability to cope with work demands Feel powerless to achieve goals Specific to the work environment, Burnout is the easiest to fix

  12. Compassion Fatigue (CF) Characterized by an emotional and physical exhaustion, a Helper can develop CF over the course of their career when they are unable to refuel and regenerate A deep erosion of our compassion and our ability to tolerate the strong emotions and difficult stories of those with whom we work Stems from absorbing the suffering of others (Figley, 2009)

  13. The Compassionate Connection

  14. Risk Factors Intensity Frequency Severity Proximity Personal Factors Previous trauma Anxiety Depression Impulsive/High-risk behaviors Substance use

  15. Where are your Skittles? Have you noticed a change in your world view or have you found that you give the best of yourself at work and have nothing left when you get home?

  16. Physical Symptoms Shock / Disbelief Sweating Rapid heartbeat Unexplained aches and pains Dizziness Impaired immune system Restlessness Sleep disturbance Appetite disturbance

  17. Impact on Professional Functioning Performance Decrease in quality and quantity Avoidance of job tasks Setting perfectionist standards Low motivation Increased mistakes Obsessing about details Morale Decrease in confidence Dissatisfaction Apathy Detachment Loss of interest Negative attitude Lack of appreciation Feelings of incompleteness Interpersonal Withdrawal from colleagues Decrease in quality of relationships Staff conflicts Impatience Poor communication

  18. Impact on Personal Functioning Withdrawal from others Decreased interest in intimacy Mistrust Intolerance Loneliness Projection of anger or blame Irritability

  19. Spiritual Symptoms of Poor Self Care Questioning the meaning of life Loss of purpose Lack of self-satisfaction Pervasive hopelessness Angry at higher power Questioning prior beliefs

  20. Do thesesymptoms leave you feeling like THIS??

  21. Protective Factors Support system Part-time work or other tasks Adequate training Work-Life balance Belief system Current coping strategies Implementation of self-care techniques Ability to recognize warning signs

  22. My Colleagues are Awful! Many Helpers find the negativity of their colleagues to be a big challenge Reframe this negativity and think of it as an organizational form of compassion fatigue, caused by the CF and VT that some of our most depleted colleagues are experiencing

  23. What Does Your Dragon Look Like? Danger Caution Health Warning

  24. Meet the Dragons

  25. Key Elements in Review CF/VT can affect an individual or can contaminate an entire workplace as a whole Not all workplaces are created equal! You could be experiencing burnout due to an unsupportive workplace in addition to CF/VT from the challenging work you do

  26. Well, Thats Lovely. Now What? Awareness is the first step What is affecting you CF? VT? Burnout? Moral Distress? A combination of two or more? Understand your warning signs What are your Big Three ?

  27. ABCs of Prevention and Maintenance Awareness Recognizing signs and symptoms Balance Taking personal responsibility Connection Seeking consultation and debriefing

  28. Have you been slimed? Debriefing vs. Venting aka sliming Self-Awareness Pay attention to how your sharing impacts others; avoid sliming Permission to come aboard Fair warning

  29. Get Control of Yourself BREATHE!!! Identify the desired outcome Steps for a desired outcome: Ask yourself what you want Identify areas in your life where you DO have control Make a plan: What s in your Self Care First Aid Kit? (Your person , snacks, stress ball, comedy, music, exercise, etc.)

  30. 4 Domains of Control to Make a Change Physical Cognitive / Attitude Existential / Meaning & Purpose Relationships No is not a four-letter word

  31. When to Seek Outside Help An increase in self-destructive or high-risk behaviors (alcohol, food, drugs/medications, spending, etc.) Missing work Increased irritability Lack of empathy towards everyone Anxiety Symptoms of depression Sleep and/or appetite disturbance Withdrawing Anhedonia/Apathy

  32. Healthy Detachment What are you in this for? Are you making it about you? Are you wanting helping someone else to provide you with a sense of satisfaction? (e.g. You re OK then I m OK ) It doesn t mean we don t care. It means we learn to love, care and be involved without going crazy. (M. Beattie, 1992) When we allow people to be who they are, then we stop trying to change things we can t. (M. Beattie, 1992)

  33. Stress Reduction Activity BANG HEAD HERE Directions 1. Place on firm, flat surface 2. Follow directions on circle 3. Repeat step 2 as necessary or until unconscious 4. If unconscious, cease stress reduction activity

  34. Guided Meditation https://vimeo.com/132790897

  35. I did the best I could with the light I had to see by - Author Unknown http://vignette2.wikia.nocookie.net/survivorsdogs/images/4/4f/Lighthouse.jpg/revision/latest?cb=20140730131304

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