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Most of us became counselors
because we wanted to assist others in need.
Yet our capacity for compassion, along with
the intensity of our work can, at times, leave
us vulnerable for "compassion fatigue."
This is a term that was coined to describe the
set of symptoms experienced by caregivers who
become so overwhelmed by the exposure to the
feelings and experiences of their clients that
they themselves experience feelings of fear,
pain, and suffering including intrusive thoughts,
nightmares, loss of energy, and hypervigilance.
It can be cumulative (from the effects helping
many clients) or occur in response to a particularly
challenging or traumatic individual case. This
extreme state of anxiety and preoccupation with
the suffering of those being helped becomes
traumatizing for the helper. For this reason
it is sometimes called "vicarious traumatization"
or "secondary traumatization"(Figley,
1995).
Who is at risk?
While our training, professionalism,
and good boundaries within our helping roles
are protective, really anyone with the capacity
for true compassion, empathy, concern and caring
is vulnerable to compassion fatigue. In other
words, the greatest strength that you have to
bring to your occupation- your capacity to develop
a compassionate connection with your clients-is
also your greatest vulnerability. Therefore,
it is not a characteristic that you would choose
to give up, rather it is more logical to educate
yourself so you understand compassion fatigue
and know what you can do if you begin experiencing
symptoms. Realize that the more prolonged exposure
to traumatic events you experience (working
too long of hours), the more personal life demands
you have, and the more isolated you become from
others collectively increase your vulnerability
for compassion fatigue.
Warning signs and symptoms
The symptoms of compassion
fatigue are similar to those of Posttraumatic
Stress Disorder, only instead of the symptoms
being based upon a trauma that you directly
experienced, they are due to the trauma that
your client(s) have experienced. Additionally,
there is a cynical, discouraged or hopeless
attitude about your work or your career that
begins to set in. Paradoxically, you may find
it difficult to leave your work at the end of
the day. You may have thoughts that preoccupy
you about a particular case. Being aware of
what these symptoms mean and how they are affecting
you is important. You can evaluate yourself
with an excellent self-assessment tool that
can be found at: http://www.proqol.org/ProQOl_Test_Manuals.html.
While this checklist is more comprehensive a
few of the predominant symptoms of compassion
fatigue are listed below:
- Feeling estranged from others
(Having difficulty sharing or describing feelings
with others)
- Difficulty falling or staying
asleep.
- Outbursts of anger or irritability
with little provocation.
- Startling easily
- While working with a victim
thinking about violence or retribution against
the person or persons who victimized.
- Flashbacks connected to my
clients and families.
- Needing more close friends.-feeling
there is no one to talk with about highly
stressful experiences.
- Working too hard for your
own good.
- Frightened of things traumatized
people and their family have said or done
to me.
- Experience troubling dreams
similar to a client of mine and their family.
- Experienced intrusive thoughts
of sessions with especially difficult clients
and their families.
- Suddenly and involuntarily
recalled a frightening experience while working
with a client or their family.
- Preoccupied with a client
or their family.
- Losing sleep over a client
and their family's traumatic experiences.
- Felt trapped by my work as
a helper.
- Felt a sense of hopelessness
associated with working with clients and their
families.
- Have felt weak, tired, rundown
as a result of my work as a helper.
- Have felt depressed as a
result of my work as a helper.
- Am unsuccessful at separating
work from personal life.
- Feel little compassion toward
most of my co-workers
- Thoughts that I am not succeeding
at achieving my life goals.
- Feel I am working more for
the money than for personal fulfillment.
- Find it difficult separating
my personal life from my work life.
- A sense of worthlessness/disillusionment/resentment
associated with my work.
Prevention, Resiliency
and Treatment
Early recognition and awareness
is crucial in being able to be resilient to
compassion fatigue. Compassion fatigue
is treatable! Keeping your life in balance or
getting it back in balance, by taking some time
off work, or enhancing your self-care are critical
techniques. Keeping your body and your health
in good shape is essential. You are not going
to be resilient if you are not well rested.
You may need medical attention if the symptoms
of compassion fatigue, such as sleep disturbance,
start interfering with your ability to function.
If you are eating poorly and not exercising
you are more vulnerable physically and emotionally
to the effects of distress. Therefore, keeping
a healthy balance in your life is a requirement
to prevent and treat compassion fatigue. Caregivers
that have a structured schedule that allow them
time to organize and do good self-care are more
resilient (Panos, 2007).
Another essential factor to
prevent and treat compassion fatigue is to have
some good relationships with either colleagues,
a supervisor, or a therapist that you can safely
and confidentially discuss the distresses you
are experiencing. Isolation is a symptom of
compassion fatigue and is ultimately dangerous.
To be resilient you need to have good support
and connections with others.
Many counselors report that
creative therapies such as writing in a journal,
or expressing their feelings through music or
art are helpful. Diversions and recreation that
allow you to take mini-escapes from the intensity
of your work is absolutely essential- not optional
as some may think. Research on resiliency in
pediatric healthcare workers show that those
that have the ability to "turn their thoughts
about work off" are more resilient throughout
their career. Sometimes this involves developing
a little ritual at the end of the day to transition
into your life outside of work, while leaving
your cares and stresses in the workplace (Panos,
2007).
What to do if you have
symptoms of Compassion Fatigue:
- Have a recognition and awareness
of the symptoms of compassion fatigue in yourself.
- Restore a healthy balance
in your life, including good sleep, good nutrition
and exercise.
- Get medical treatment for
those symptoms that are interfering with your
daily functioning.
- Utilize your positive supportive
connections with others to process your feelings.
- Implement regular mini-escapes
in your life, like recreation, creative therapies
or other healthy diversions from the intensity
of your work.
- Don't medicate yourself with
drugs or alcohol! Don't use other self-defeating
addictions! Get professional help for yourself
if needed to get back on track.
Conclusion
Unrecognized and untreated
compassion fatigue causes people to leave their
profession, fall into the throws of addictions
or in extreme cases become self-destructive
or suicide. It is important that we all understand
this phenomenon for our own well-being, but
also for our colleagues. If you notice a colleague
in distress- reach out to them. Give them this
article and let them know you care and are available
to talk if they need.
Angelea Panos, Ph.D. is
a therapist that specializes in trauma and grief,
she has 20 years of experience in helping survivors.
She is a board member of Gift From Within.
Websites with information
or resources on Compassion Fatigue
Gift From Within-PTSD Resources-
www.giftfromwithin.org
DVD When Helping Hurts: Preventing
& Treating Compassion Fatigue- http://www.giftfromwithin.org/html/video4.html#4b
http://www.proqol.org/ProQOl_Test_Manuals.html.
Green Cross Foundation. www.greencross.org
References and Suggested
Reading:
Boscarino, J. A., Figley, C.
R. and Adams, R. E. (2004). Evidence of Compassion
Fatigue following the September 11 Terrorist
Attacks: A Study of Secondary Trauma among Social
Workers in New York. International Journal
of Emergency Mental Health, 6:2, 98-108.
Figley, C.R. (1982). Traumatization
and comfort: Close relationships may be hazardous
to your health. Keynote presentation, Families
and close relationships: Individuals in social
interaction. Conference held at the Texas Tech
University, Lubbock, March.
Figley, C.R. (1993a). Compassion
Stress: Toward Its Measurement and Management.
Family Therapy News, February, 1-2.
Figley, C.R. (1993b). Compassion
Fatigue and Social Work Practice: Distinguishing
Burnout from Secondary Traumatic Stress. Newsletter
of the NASW Florida Chapter, June, 1-2.
Figley, C.R. (Ed.) (1995). Compassion
Fatigue: Coping with Secondary Traumatic Stress
Disorder in Those Who Treat the Traumatized.
An Overview. 1-20. New York: Brunner/Mazel.
Figley, C. R. and Roop, R. (2006).
Compassion Fatigue in the Animal Care Community.
Washington, DC: The Humane Society Press.
Panos, A (February, 2007). Promoting
resiliency in trauma workers. Poster presented
at the 9th World Congress on Stress, Trauma,
and Coping, Baltimore, MD.
Pines, A. & Aronson, E.
(1988). Career burnout: Causes and cures. New
York: Free Press.
Saakvitne, K.W., Gamble, S.G.,
Pearlman, L.A., & Lev, B.T. (2000). Risking
connection: A training curriculum for working
with survivors of childhood abuse. Lutherville,
MD: Sidran Foundation and Press.
Seligman, M. E. P., Steen, T.
A., Park, N. & Peterson, C. (2005). Positive
psychology progress: Empirical validation of
interventions. American Psychologist,
60:5, 410-421.
Solomon, Z. (1993). Combat Stress
Reaction : The Enduring Toll of War. NY: Springer.
Copyright 2007 Gift
From Within- a non-profit organization serving
PTSD clients and professionals. Website: www.giftfromwithin.org
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