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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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