Burnout &

Compassion

Fatigue

Debra Hopkins

Staff Development & Training Coordinator

August 2013

OBJECTIVES

• Discover what leads to burnout and

compassion fatigue in your work

• Identify coping strategies that you can use

to increase your resiliency

• Develop ways to find support for yourself

and give support to your colleagues

• Help supervisors manage burnout and

compassion fatigue in the workplace

Personal Mission Statement

Take some time to complete

your personal mission

statement.

You will look at it again at the

end of the course.

The Data • 57% of social workers have been threatened &

16% physically assaulted

• 40% of nurses have been physically assaulted

• 52% of behavioral health staff are at medium to

high risk for anxiety and depression disorders,

which is twice as high than the general

population

• Twice as many nurses used EAP than the

general employee population

• 59% of mental health professionals are willing to

seek help vs. 15% of law enforcement

professionals

Major Health Concern

Increased recognition of negative impact

on organizations – causes significant

work place disturbances

• High Attrition

• Poor Employee Retention

• Soaring Long Term Disability and Sick

Leave costs

Definitions

Burnout: “Exhaustion of physical or

emotional strength or motivation usually as

a result of prolonged stress or frustration

that gradually builds to a breaking point.”

Compassion Fatigue: “A debilitating

weariness brought about by repetitive,

empathic response to pain and suffering,

compassion fatigue is a result of absorbing

and internalizing the emotions of clients and,

sometimes, co-workers….”

Burnout

Occurs when there is no joy left in doing

your job and you feel exhausted.

You often feel apathetic, a loss of emotional

investment, and an adoption of “what’s the

point?” attitude.

Burnout

Physical & emotional exhaustion as a

result of prolonged stress and

frustration

Depleted ability to cope with work

demands

Sense of powerlessness to achieve

goals

Alters our view of the workplace

Can happen in any occupation

Compassion Fatigue

“A state of exhaustion and dysfunction,

biologically, psychologically and socially, as a

result of prolonged exposure to secondary

trauma or a single intensive event.” (Figley,

1995)”

Series of psychosocial and emotional factors

caused by a specific event or events

indirectly affecting helpers.

Emotional fallout from delivering services to

those that were primarily traumatized.

When was Compassion Fatigue Defined?

First diagnosed in Nurses in the 1950s. It

has also been discovered in other giving

professions, including social workers,

doctors, disaster response/relief workers,

attorneys, and charity workers, as well as

other “helping” professions.

Compassion fatigue has been studied by the

field of traumatology where it has been

called the “cost of caring” for people facing

other’s emotional pain.

The Compassion Fatigue Process

Figley, 2001

Who is More Likely to Develop

Compassion Fatigue….?

….Anyone with the capacity for true

compassion, empathy, concern & caring.

We try to stay within professional

boundaries and adhere to the training

guidelines we received.

However, our greatest strength, our

compassionate connection, is also our

greatest vulnerability.

This is not a characteristic to throw away.

Symptoms of Compassion Fatigue

Emotional • Despair

• Hopelessness/Helplessn

ess

• Decreased Pleasure

• Stress & Anxiety

• Negative Attitude

• Overwhelmed

• Powerlessness

• Guilt

• Anger/Rage

• Survivor’s Guilt

• Shutdown

• Numbness – No Joy

• Fear

• Sadness

• Depression

• Emotional Roller Coaster

• Overly Sensitive

• Vulnerable Feeling

• Drained

• Association with Trauma

Affects You Deeply

Symptoms of Compassion Fatigue

Behavioral • Impaired Judgment

• Impatient

• Irritable

• Withdrawn

• Moody

• Sleep Disturbance

• Nightmares

• Appetite Changes

• Hyper Vigilant

• Startle Response

• Accident Prone

• Lose Items

• Negative Reaction to

Small Changes

Symptoms of Compassion Fatigue

Cognitive • Poor Concentration

• Low Self-Esteem

• Apathy

• Rigidity

• Disorientation

• Perfectionism

• Minimization

• Preoccupation with

Trauma

• Thoughts of Self-harm or

Harm to Others

Symptoms of Compassion Fatigue

Personal

Relationships • Decreased Interest in

Intimacy or Sex

• Mistrust

• Isolation

• Parental Over Protection

• Projection of Anger or

Blame

• Intolerance

• Loneliness

• Interpersonal Conflicts

Symptoms of Compassion Fatigue

Physical/Somatic • Shock

• Sweating

• Rapid Heartbeat

• Hypertension

• Breathing Difficulties

• Aches & Pains

• Dizziness

• Headaches

• Increased Number &

Intensity of Medical

Maladies

• Impaired Immune

System

• Other Somatic

Complaints - the mind or

environment affecting the

body

• Substance Abuse

• Recurring Thoughts

About a particular Case

Symptoms of Compassion Fatigue

Work Performance • Low Morale

• Low Motivation

• Avoiding Tasks

• Obsession Over Details

• Apathy

• Negativity

• Lack of Appreciation

• Detachment

• Poor Work Habits

• Staff Conflicts

• Absenteeism

• Chronic Lateness

• Withdrawal Form

Colleagues

• Personal Issues Intrude

on Work

• Workaholism – cynical &

discouraged yet can’t leave

work

• Diminished Sense of

Personal

Accomplishment

Symptoms of Compassion Fatigue

Spiritual

• Question the

Meaning of Life

• Loss of Purpose

• Lack of Self-

Satisfaction

• Anger at God

• Question Religious

Beliefs

• Loss of Faith

• Skepticism

• Inability to

Maintain Balance

of Empathy &

Objectivity

Primary vs. Secondary Trauma

Primary Trauma:

• A consequence of one’s work, i.e. EMS, car

accidents, fatalities involving children

• From our personal lives, our own past

• Post Traumatic Stress Disorder

Secondary Trauma:

• “Trauma Reactions that involve other’s trauma

imagery or trauma stories characterized by

panic, horror, or helplessness in relation to the

event.” (Tikasz)

Other Forms of Compassion Fatigue

1. Secondary Traumatic

Stress Disorder

2. Secondary Victimization

3. Vicarious Trauma

4. Emotional Hijacking

5. Cumulative Stress

SMALL GROUP EXERCISE # 1

Discuss a case that caused you to “take it

home” with you or caused symptoms of

compassion fatigue.

Identify the factors that caused you to

relate to the person/victim/family/event.

Note the commonalities among you and

choose a person to share this with the

class.

Secondary Traumatic

Stress…

….when a client is experiencing a trauma

that you have personal experience with,

past emotions may be triggered, along

with feelings and personal trauma.

Some examples are homelessness,

physical abuse, emotional abuse,

hospitalization, illness, death of a loved

one.

Secondary Victimization…

….when helping a client that is victim to

sexual, physical, or emotional abuse, you

may experience the trauma caused by

these events first-hand, though you didn’t

experience the event first-hand.

Vicarious Trauma…..

PTSD-related symptoms from working

with clients and families that have trauma

and grief:

May co-exist with burnout

May occur from exposure to one

case or a cumulative level of trauma

(Figley, 1995)

Vicarious Trauma….

….when a client’s traumatic experiences

affect you deeply even though you are

experiencing the trauma second hand.

• Vicarious: experienced through another by

imagining: experienced through somebody

else rather than at first hand, by using

sympathy or the power of the imagination

• endured for somebody else: done or endured

by somebody as a substitute for somebody

else

Vicarious Trauma…. Repeated exposure to difficult stories

changes our view of the world

Results in nightmares, certain images

repeated, intense preoccupation with a

story or event

“When external trauma becomes an

internal reality it impacts the entire

nervous system” (Lipsky, 2009)

Accumulates over time and across clients

Occupational Hazard

Occupational Hazard We do not get Compassion Fatigue or

Vicarious Trauma because we made

mistakes

We get it because we CARE

It is a natural consequence of trauma

exposure

Emotional Hijacking…

….when your client’s emotions are strong

and you “catch a ride” experiencing their

emotions to a high degree.

Cumulative Stress…

….when your are unable to relieve

stresses that build, they add up and take

a toll, which can reach a critical point if

not addressed.

Burnout vs. Compassion Fatigue

Compassion

Fatigue

Yes No

DO I LOVE MY JOB?

Burnout

QUIZ

Life Stress Test

Professional Quality of Life Scale -

Compassion Satisfaction And

Compassion Fatigue (PROQOL)

Results are private and are to be used

for self-awareness and self-care.

How do these areas

of our lives

influence each

other?

The Cost of Compassion

Fatigue…..

….At work: Reduced Productivity

Negative influence on co-workers and

their productivity

Not able to serve clients to the best of

your ability

The Cost of Compassion

Fatigue….. ….At work: “The cost of providing care is staggering.

The cost of not providing care, especially for

care providers is even more staggering. Job

stress is estimated to cost American

Industry 200 – 300 billion dollars annually as

assessed by absenteeism, diminished

productivity, employee turnover, accidents,

direct medical, legal and insurance fees,

worker’s compensation, etc.”

The Cost of Compassion

Fatigue…..

….To You: Reduced effectiveness in all areas

Lowered self-esteem

Feeling guilty for not fulfilling

commitments

The Cost of Compassion

Fatigue…..

….To Those You Love: You are emotionally drained or

unavailable

Feeling disconnected or aloof

Take Steps to Reduce

Compassion Fatigue

1. Social Supports

2. Self-Awareness

3. Meditation

4. Reduce Caseload

5. Limit Trauma Inputs

6. Work/Life Balance

7. Develop Resiliency

Social Support……

…in the workplace “is the most

significant factor associated with

compassion satisfaction (Killian study

of trauma counselors)

…colleagues

…friends

…family

…church

…pets

Self Awareness

Psychoneuroimmunology

Dr. Gabor Maté • Long term effects of chronic

stress…..our immune system

does not exist in isolation

from daily experience.

• Chronically high cortisol

levels destroy tissue.

• Chronically elevated

adrenalin levels raise blood

pressure and damage the

heart.

Self Awareness Being aware of feelings, actions & reactions, and gaining

an understanding of how I deal with anger, hurt,

resentment.

• Do I swallow my rage? Where in my body do I feel my

anger?

Being in tune with my stress signals.

• Do I have a good sense of how my body communicates

to me when I get overwhelmed? Do I get sick as soon

as I go on vacation, or develop hives or get a migraine

when I am stressed?

• Am I aware of the ways in which I sabotage my self-

care? By saying yes to requests I do not have time for,

by taking on more responsibilities, by cancelling a

therapy appointment?

Self Awareness Being aware of the dynamics from our past that

influence the every day choices we make:

• Why did I choose to go into this field and not

another?

• Did I pick this profession because of a trauma or

loss I experienced in my own life?

• Was I already a helper in my family of origin?

• Am I the “go to” person in my personal life?

• Do I feel empty or unimportant unless I am in a

helping role?

Understanding how my own childhood history affects

my reactions to my clients’ stories (counter

transference).

Meditation Mindfulness Based Stress Reduction

Jon Kabat Zinn defines as, "a moment-to-

moment, non-judgmental awareness."[

25 years of studies demonstrate that MBSR

helps reduce emotional distress and manage

severe physical pain.

MBSR has been used successfully with patients

suffering from chronic pain, depression, sleep

disorders, cancer-related pain and high blood

pressure. (Cohen-Katz t. al.)

www.compassionfatigue.ca

Reduce Caseload

Rebalancing & Reducing

Caseload/Workload

To combat compassion fatigue and

burnout, agency administrators may want

to ask themselves, “How many cases are

too many for staff to be effective for

clients?”

Two kinds of debriefing (1) the informal debrief, which often takes place in a

rather ad hoc manner, whether it be in a

colleague’s office at the end of a long day or in the

staff lunchroom, where the recipient of the

traumatic details, rarely has a choice in receiving

this information.; and

(2) the formal debrief which is a more structured

process, and is normally scheduled ahead of time

and often referred to as peer consultation,

supervision or critical incident stress debriefing,

which lacks immediacy in the case of vicarious or

secondary trauma.

Low Impact Debriefing Preventing Re-Traumatization

1) Increased Self Awareness

Were all those details necessary to the storytelling?

2) Fair Warning

If I know that you are coming to tell me a traumatic story, I will

be prepared to hear this information and it will be less

traumatic for me to hear.

3) Consent

The listener has a chance to decline, or to qualify what they

are able/ready to hear.

4) Limited Disclosure

Decide how much to share. How much detail is enough?

How much is too much?

Improve Work/Life Balance

Duxbury Report on role overload in health

care:

1) 35% of health care workers suffer from role

overload

2) 36% report high levels of depressed mood

3) 1 in 4 employees were planning to leave

their job at the hospital, not for higher pay, but

for greater control over work hours and for

more respect.

Improve Work/Life Balance

Relationships

Environment (clutter, etc.)

Work

Money

Mind, Body, Spirit

Develop Resiliency

Help for the Helper: The Psychophysiology

of Compassion Fatigue and Vicarious

Trauma (Norton Professional Books)

…the ability to keep on going

when the going gets tough….

Research shows that those who

can “turn off thoughts about

work” are more resilient during

their careers

Self-Care

Are you aware of your specific

vulnerabilities?

How do you protect yourself

while doing this very challenging

work?

Were you trained for this?

Mother Theresa…..

…..wrote in her plan to her

superiors that it was

mandatory for her nuns to

take an entire year off from

their duties every 4 to 5

years to allow them to heal

from the effects of their

care-giving work.

QUIZ

Compassion

Satisfaction/Fatigue Self-Test

for Helpers

Results are private and are to be used

for self-awareness and self-care.

SMALL GROUP EXERCISE # 2 Discuss the causal factors of Compassion

Fatigue.

o Each helper’s empathic engagement with each

client’s unique experience

o Helper’s unique personal response based on

personal history, style, current life

circumstances, as well as proximity and

personal connection to the events and people

involved in the trauma/tragedy

Discuss potential consequences for

undiagnosed and untreated compassion

fatigue.

The ABC’s of Prevention

Awareness

Balance

Connections

More on Awareness 1. What types of cases contribute to your

stress level?

2. What events or situations cause you to

experience unusually strong reactions?

3. Which cases overpower your usual

coping mechanisms?

4. Are ordinary incidents becoming

“traumatic”?

5. Is your ability to function altered?

6. Are you losing your normal boundaries?

More on Awareness

7. Do you regularly wake up tired and struggle

to get to work?

8. Do you feel as if you are working harder yet

accomplishing less?

9. Are you becoming frustrated/irritated easily?

10.Are you losing compassion for some while

becoming over involved with others?

11.Do you routinely feel bored or disgusted?

12.Are you experiencing illness, aches &

pains?

Balance

1. Practice excellent self-care.

2. Nurture yourself by including activities

in your schedule that are sources of

joy, pleasure, and diversion.

3. Allow yourself to take mini-escapes to

relieve the intensity of your work.

4. Transform the negative impact of your

work; find meaning, challenge

negativity, find gratitude.

Dr. Francis J. Braceland…..

…..”We can be sure

that the greatest

hope for maintaining

equilibrium in the

face of any situation

rests within

ourselves….”

Balance Find Hidden Passion

• We all have hidden sources of energy

and healing power.

• When you identify the things that fuel

you, the things that you have true

passion for, your fatigue will disappear.

• Balancing life involves including the

things that you value and have passion

for in your schedule.

Balance

The Yoga Sūtras of Patañjali

are 196 Indian thoughts written

in a memorable form.

“When you are inspired by

some great purpose, some

extraordinary project, all your

thoughts break their bonds:

your mind transcends

limitations, your consciousness

expands in every direction, and

you find yourself in a new,

great, and wonderful world.

Dormant forces, and talents

become alive, and you discover

yourself to be a greater person

by far than you ever dreamed

yourself to be”

Balance • Meditation is an excellent way to ground yourself in the

moment and keep your thoughts from pulling you in

different directions.

• The ability to connect with a spiritual source will help you

achieve inner balance and produce a significant turn-a-

round, even when your world seems dark.

• Have a quiet time alone in a calm, beautiful place, a safe

retreat where you feel renewed.

• Find ways to acknowledge loss & grief.

• Remain clear and true to career goals and personal

mission.

• Focus on what you can control.

• View situations as challenges & opportunities rather as

problems or stresses.

Balance Re-charge Your Batteries Daily:

• Commit to a nutritious diet and stop all other

activities while eating. This will have an exponential

benefit on both your psyche and physical self.

• Regular exercise will reduce stress, help you

achieve balance and re-energize you for time with

family & friends.

• Spend time daily on an activity you find meaningful

that is not related to work. This may be something

you do alone or with others; reading, walking,

listening to music, playing with pets, a hobby,

whatever energizes you.

SMALL GROUP EXERCISE # 3

List one mini-escape or

diversion that worked well

to restore and renew you.

List one thing that brings

you joy.

Connections • Hold one focused, connected and meaningful

conversation each day. Sadly, this is the first thing to go

when time is scarce. Time with family and close friends

create feelings of connectedness and belonging that are

lost when experiencing compassion fatigue.

• Talk about your stress; process your thoughts with

someone – co-worker, therapist, clergy, friend, family,

supervisor.

• Build a positive support system that supports you (not

fuels your stress)

• Blood pressure and heart rate decrease when interacting

with animals. Pets are invulnerable to “provider

burnout”.

Words of Advice • Do not quit your job

• Do not make a significant relationship decision

• Do not make a lavish spending decision

• Do not blame colleagues

• Do not blame administration

• Do not blame “The system”

• Do not initiate legal action

• Do not spend your energy complaining habitually

• Avoid commiserating with discontented colleagues

• Do nut try quick fixes such as alcohol or drugs

Managing Workplace

Toxicity

• Avoid feeling wronged and bitter, a

sense of helplessness, of being

persecuted

• We become convinced, by ourselves

and others if we allow it, that others are

responsible for our well-being and that

we lack the personal resources to

transform our thoughts, actions and

circumstances.

CONCLUSION

Unrecognized and Untreated

Compassion Fatigue causes people to:

• Leave their professions

• Self-Treat with Drugs or Alcohol

• Become Suicidal or Self-Destructive

Watch Out for Each Other.

If You See a Colleague in Distress,

Reach Out to Them.

Maya Angelou…..

…..”The quality of

strength lined with

tenderness is an

unbeatable

combination….”

On-line Resources

Compassion Fatigue Awareness Project

www.compassionfatigue.org

Compassion Fatigue

http://www.breathofrelief.com

Personal Mission Statement

Look at your Personal Mission

Statement again. Do you see

things any differently after

examining yourself more

closely today?

Take Good

Care of

Yourself!