compassion fatigue and cpsc referrals sasd 11-14-13...references) boscarino,j.a.,...
TRANSCRIPT
Controlling Compassion Fa/gue
Presented by: Shaney McCoy, CMHC Weber State University Counseling & Psychological Services Center 801-‐626-‐6406 [email protected]
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