compassion fatigue and cpsc referrals sasd 11-14-13...references) boscarino,j.a.,...

Controlling  Compassion  Fa/gue  

Presented  by:    Shaney  McCoy,  CMHC  Weber  State  University  Counseling  &  Psychological  Services  Center  801-­‐626-­‐6406  shaneymccoy@weber.edu  

Presenta/on  for  Student  Affairs  Staff  Development  

What  is  Compassion  Fa/gue?  

"...the  overall  experience  of    

emo$onal  and  physical  fa$gue    

that  social  service  professionals  experience    due  to  the  chronic  use  of  empathy    

when  trea/ng  pa/ents  who  are  suffering  in  some  way."

(Newell & MacNeil, 2010)

Who  is  Affected  by  Compassion  Fa/gue?  

Ini/al  focus  of  studies:    Nurses    Emergency  Responders    Mental  health  professionals    Social  Workers  

Now  recognized  in:    Doctors  and  other  health  care  providers    Veterinarians  and  other  animal  care  providers    Volunteers    Jus/ce  system  employees    Prison  workers    Others  –  Like  Student  Affairs  staff  members!  

Components  of  Compassion  Fa/gue  

Burnout   Secondary  Trauma/c  Stress  

(CF  construct  valida/on:  Boscarino  et  al,  2004)  

Burnout  

   “…a  state  of  physical,  emo/onal,  psychological,  and  spiritual  exhaus/on  resul/ng  from  chronic  exposure  to  (or  prac/ce  with)  popula/ons  that  are  vulnerable  or  suffering.”                                        (Pines  and  Aronson,  1998)  

Secondary  Trauma/c  Stress  Nearly  iden/cal  to  PTSD,  but  trauma  is  not  experienced  first-­‐hand.    May  include:  

•   Avoidance  •  Intrusive  thoughts  •  Flashbacks/dreams  •  Physiologic  distress  at  internal  or  external  cues  •  Increased  arousal  (sleep  difficul/es,  irritability,  hypervigilance,  concentra/on  problems,  increased  startle  response)  

(CF  construct  valida/on:  Boscarino  et  al,  2004)  

Look  familiar?  

What  does  CF  feel  like?  Physical Signs and Symptoms

§  Physical exhaustion §  Insomnia or hypersomnia §  Headaches/migraines §  Increased susceptibility to illness §  Somatization and hypochondria

Behavioral Signs and Symptoms

§  Increased use of alcohol and drugs §  Other addictions §  Absenteeism §  Anger and irritability §  Exaggerated sense of responsibility §  Avoidance of clients §  Impaired ability to make decisions §  Forgetfulness §  Problems in personal relationships §  Compromised care for clients §  The silencing response

Psychological Signs and Symptoms §  Emotional exhaustion §  Distancing §  Negative self-image §  Depression §  Reduced ability to feel sympathy and empathy §  Cynicism and embitterment §  Resentment §  Dread of working with certain clients §  Feeling of helplessness §  Diminished sense of enjoyment in volunteering §  Depersonalization §  Disruption of world view, heightened anxiety,

irrational fears §  Increased sense of personal vulnerability §  Inability to tolerate strong feelings §  Problems with intimacy §  Hypervigilance §  Intrusive imagery §  Hypersensitivity to emotionally charged stimuli §  Insensitivity to emotional material §  Loss of hope §  Difficulty separating personal and professional

lives §  Failure to nurture and develop non-professional

aspects of life (Adapted from Mathieu, 2012)

Experiences  

 I’ll  tell  you  mine  if    you’ll  tell  me  yours…      

Personal  Risk  Factors  

“Those  who  have  enormous  capacity  for  feeling  and  expressing  empathy  tend  to  be  more  at  risk  of  compassion  stress.”  (Figley,  1995)  

   “The  single  largest  risk  factor  for  developing  professional  burnout  is  human  service  work  in  general.”  (Newell &  MacNeil,  2010)  

Personal  Risk  Factors  

Empathy:  We’re  hardwired!    

So,  I’m  at  risk…  what  now?  

Awareness   Self-­‐Care  

Team  Support  

Self-­‐Care  

Physical  sensa/

ons  

Same  experiences,  now  lighter  and  

filtered  of  deleterious  effects.  

Direct  witne

ss  of  anothe

r’s  

trauma,  or  b

earing  witne

ss  

through  liste

ning  to  

 their  narra/

ve…  

Self-­‐Care  Ideas  •  Limit  exposure  to  empathic  pulls  (media,  etc.)  •  Take  breaks  •  Debrief  with  team,  friends,  family  •  Balance  –  work,  school,  exercise,  play,  nutri/on,  spirituality,  sleep,  volunteering  

•  Engage  in  counseling  •  Create  ritual  around  ending  shiks  •  Write  in  a  journal  •  U/lize  image  manipula/on  •  Others  ideas?  

Remember…  

Apply  your  own  oxygen  mask  before  amemp/ng  to  help  others!  

Suppor/ng  Your  Team  

Don’t  bury  your  head  in  the  sand!  Acknowledge  that  compassion  fa/gue  is  not  only  possible,  but  PROBABLE,  

when  there  are  heavy  demands  on  our  empathic  responses.  

Suppor/ng  Your  Team  

Let  your  team  members  know  they  can  talk  to  you,  each  other  or  professionals  without  fear  of  s/gma.  

Suppor/ng  Your  Team  

Reduce  sense  of  powerlessness  in  team  members.  

Suppor/ng  Your  Team  Debriefing  is  important!  But  it  is  possible  to  have  too  much  of  a  

good  thing.  Create  a  team  culture  that  supports  Limited  Impact  Debriefing.  

§  Be  aware  of  the  need  to  debrief  

§  Offer  a  fair  warning  §  Obtain  consent  §  Disclose  with  inten/on  

Discussion  

What  might  you  do  differently  in  the  future?    

Thank  You  for  All  You  Do!  

Any  ques/ons?  

Reading  Resources  

•  Help  for  the  Helper:  The  Psychophysiology  of  Compassion  Fa$gue  and  Vicarious  Trauma  (Babeme  Rothschild)  

•  The  Compassion  Fa$gue  Workbook        (Francoise  Mathieu)  

•  Transforming  the  Pain:  A  Workbook  on  Vicarious  Trauma$za$on                                                      (Laurie  Pearlman)  

•  Trea$ng  Compassion  Fa$gue            (Charles  Figley)    

References  Boscarino,  J.A.,  Figley,  C.R,  Adams,  R.E.  (2004).  Compassion  fa/gue  following  the  September  11  terrorist  

 amacks:  A  study  of  secondary  trauma  among  New  York  City  social  workers.  Interna$onal    Journal  of  Emergency  Mental  Health,  6(2),  57-­‐66.  

Figley,  C.R.  (1995).    Compassion  fa/gue  as  secondary  trauma/c  stress  disorder:  An  overview  (chapter  1,    pp  1  -­‐  20)  in  book:  Compassion  Fa/gue:  coping  with  secondary  trauma/c  stress  in  those    who  treat  the  trauma/zed”,  edited  by  Figley;  from  Brunner/Mazel  Psychosocial  Stress    Series,  no.  23)  

Mathieu,  F.  (2012).  The  compassion  fa$gue  workbook:  Crea$ve  tools  for  transforming    compassion  fa$gue  and  vicarious  trauma$za$on.  New  York:  Routledge.  

Newell,  Jason  M.  &  MacNeil,  Gordon  A.  (2010).  Professional  Burnout,  Vicarious  Trauma,  Secondary    Trauma/c  Stress,  and  Compassion  Fa/gue:  A  Review  of  Theore/cal  Terms,  Risk  Factors,  and    Preven/ve  Methods  for  Clinicians  and  Researchers.  Best  Prac$ces  in  Mental  Health:  An    Interna$onal  Journal,  Vol  6(2),  57-­‐68.  

Pearlman,  L.  A.,  &  Saakvitne,  K.  (1995).  Trauma  and  the  therapist:Countertransference  and  vicarious    trauma$za$on  in  psychotherapy  with  incest  survivors.  New  York:  W.  W.  Norton.  

Pines,  A.,  Aronson,  E.  (1988).  Career  burnout:  Causes  and  cures.  New  York:  Free  Press  Rothschild,  B.  (2006).  Help  for  the  Helper.  NY:  W.W.  Norton  &  Company,  Inc.  Stamm,  B.H.  (2010).  The  Concise  ProQOL  Manual,  2nd  Ed.  Pocatello,  ID:ProQOL.org.        

Dianna Abel, Ph.D., Director

Making Effective Referrals

to the Counseling and Psychological

Services Center

I. Self-Awareness

II. Symptom Awareness

III. Making the Referral

IV. Crisis Intervention at CPSC

◘  Feelings  ◘  Worry,  preoccupa/on  ◘  Suspicion,  doubt  ◘  Uneasiness,  hesitance  ◘  Anxiety,  dread  ◘  Fear  

◘  Behaviors  ◘  Frequent  consulta/on  ◘  Boundary  stretching  ◘  Avoidance  ◘  Safety  measures  

Self-­‐Awareness  

◘  Academic/Employment  Concerns  ◘  Uncharacteris/cally  poor  work  ◘  Excessive  absences  ◘  Difficulty  concentra/ng  ◘  Poor  or  un/mely  follow-­‐through  ◘  Disrup/ve  behavior  ◘  Alarming  content  in  wrimen  work    

Symptom  Awareness  

◘  Interpersonal  Concerns  ◘  Difficulty  gevng  along  with  others  ◘  Social  isola/on  or  awkwardness  ◘  Extreme  defensiveness,  externaliza/on  ◘  Boundary  viola/ons:  

◘  Inappropriate  disclosures  regarding  personal  problems  

◘  Failure  to  operate  within  expected  role  structures  ◘  Excessive  support-­‐seeking  

◘  Time  ◘  Resources  ◘  Assistance  

Symptom  Awareness  

◘  Behavioral  Concerns  ◘  Irritability,  agita/on,  restlessness  ◘  Intense,  drama/c,  or  vola/le  emo/on  ◘  Fa/gue  ◘  Anhedonia:  Loss  of  interest  in  pleasurable  

ac/vi/es  ◘  Changes  in  personal  hygiene  ◘  Inappropriate  responses  and/or  disjointed  

thoughts  ◘  Physical  harm  to  self  ◘  Suicidal/homicidal  thoughts  or  plans    

Symptom  Awareness  

 If  you’re  concerned  about  a  student…  ◘  Trust  your  gut  ◘  Share  your  observa/ons  

◘  “I’ve  no/ced…”  

◘  Express  your  concerns  ◘  “I’m  concerned  that  you’re  struggling  and  could  use  a  

different  kind  of  help.”  

◘  Normalize  the  student’s  experience  ◘  “Lots  of  students  struggle  with  these  issues.”  

◘  Refer  to  CPSC  ◘  “Fortunately,  help  is  available  right  here  on  campus!”  

Making  the  Referral  

 Referring  a  student  in  crisis…    ◘  Determining  level  of  need  ◘  Scheduling  the  appointment  ◘  Understanding  confiden/ality  

◘  Following  up    ◘  Sharing  vs.  receiving  

◘  Taking  care  of  yourself  

◘  Ques/ons?  

Crisis  Interven;on  at  CPSC  

Thank you!

Dianna Abel, Ph.D., Director