Empathy Fatigue: Dealing Empathy Fatigue: Dealing Effectively with the Stress and Effectively with the Stress and

Grief Reactions of Grief Reactions of Extraordinary Stressful and Extraordinary Stressful and

Traumatic EventsTraumatic EventsMark A. Stebnicki, Ph.D., LPC, CRC, Mark A. Stebnicki, Ph.D., LPC, CRC,

CCMCCM

Professor, Dept. of Rehab StudiesProfessor, Dept. of Rehab Studies

East Carolina UniversityEast Carolina University

www.ecu.edu/rehbwww.ecu.edu/rehb

Empathy Fatigue: Healing the Mind, Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional Body, and Spirit of Professional CounselorsCounselors((Springer Publishing -2008)Springer Publishing -2008)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Personal Testimonials of Persons’ Personal Testimonials of Persons’

Experience of Empathy FatigueExperience of Empathy Fatigue

Purpose and Intent Purpose and Intent

Identify & Recognize Critical PathwaysIdentify & Recognize Critical Pathways to Empathy Fatigue (EF) and other to Empathy Fatigue (EF) and other professional fatigue syndromes.professional fatigue syndromes.

Describe Cumulative effects and ImpactDescribe Cumulative effects and Impact on the professional counselor which leads to on the professional counselor which leads to the deterioration of the counselor’s the deterioration of the counselor’s empathic engagement with their clients.empathic engagement with their clients.

Provide Self-care StrategiesProvide Self-care Strategies for pre- for pre-professionals, counselor educators and professionals, counselor educators and supervisors that cultivate healthy coping supervisors that cultivate healthy coping and resiliency.and resiliency.

A Consciousness Shift in the Counseling A Consciousness Shift in the Counseling and Allied Helping Professionsand Allied Helping Professions

September 11, 2001 (2,996 deaths)September 11, 2001 (2,996 deaths) War in Afghanistan & Iraq (4,493 U.S. Soldiers; War in Afghanistan & Iraq (4,493 U.S. Soldiers;

88,456 Iraqi Civilian deaths +)88,456 Iraqi Civilian deaths +) Tsunami December 26Tsunami December 26thth 2004 (275,000 deaths in 11 2004 (275,000 deaths in 11

countries countries Hurricane Katrina 2005 (70 deaths +)Hurricane Katrina 2005 (70 deaths +) Child Deaths by intentional-unintentional gun violence Child Deaths by intentional-unintentional gun violence

(3,024yr)(3,024yr) School deaths due to violence (92-98 171; 99-08 250)School deaths due to violence (92-98 171; 99-08 250) Cumulative AIDS-related deaths in U.S (through 2002 Cumulative AIDS-related deaths in U.S (through 2002

501,669d); Ethiopia (1.8 mil predicted by ’08)501,669d); Ethiopia (1.8 mil predicted by ’08)

Healthy Occupational Outlook for CounselorsHealthy Occupational Outlook for Counselors

Fire Fire Flood Flood Hurricanes/Hurricanes/

TornadosTornados Ice stormsIce storms Plane crashesPlane crashes VolcanoesVolcanoes EarthquakesEarthquakes EpidemicsEpidemics

Workplace violenceWorkplace violence Traumatic injury in Traumatic injury in

the workplacethe workplace School shootingsSchool shootings BioterrorismBioterrorism Transportation Transportation

AccidentsAccidents Civil UnrestCivil Unrest 22ndnd Depression Depression

A Constant State of Disaster A Constant State of Disaster Preparedness: Crisis Response TeamsPreparedness: Crisis Response Teams

ARC/State Disaster MHARC/State Disaster MH EMS/IC-EMEMS/IC-EM Law/FireLaw/Fire Public HealthPublic Health DSSDSS School CounselorsSchool Counselors CISM TeamsCISM Teams MH/LMEMH/LME EAPsEAPs

Baptist MenBaptist Men Salvation ArmySalvation Army United WayUnited Way FEMAFEMA National National

Guard/MilitaryGuard/Military Insurance AdjustorsInsurance Adjustors MediaMedia Airline IndustryAirline Industry Banks/Financial Banks/Financial

InstitutionsInstitutions

Empathy Fatigue (EF)Empathy Fatigue (EF)

“ “ A dynamic state of psychological, A dynamic state of psychological, emotional, social, physical, emotional, social, physical, occupational, and spiritual exhaustion occupational, and spiritual exhaustion that occurs on a continuum, resulting that occurs on a continuum, resulting from the helpers’ own wounds that from the helpers’ own wounds that are continually revisited by their are continually revisited by their client’s life-stories of stress, chronic client’s life-stories of stress, chronic illness, mental/physical disability, illness, mental/physical disability, trauma, grief, and loss.”trauma, grief, and loss.”

EF-The Wounded Healer ExperienceEF-The Wounded Healer Experience

Traditional Native American teachings “each Traditional Native American teachings “each time you heal someone you give away a piece time you heal someone you give away a piece of yourself until at some point you require of yourself until at some point you require healing.”healing.”

The wounded healer phenomenon has been The wounded healer phenomenon has been noted throughout the history of counseling, noted throughout the history of counseling, psychology, and through spiritual leaders psychology, and through spiritual leaders (Jung Nouwen, Rogers, Dali Lama) (Jung Nouwen, Rogers, Dali Lama)

Journey to become a counselor, healer, or Journey to become a counselor, healer, or Shaman comes with the understanding that Shaman comes with the understanding that there is a cost to M-B-S.there is a cost to M-B-S.

EF- Both Same and Different as Other EF- Both Same and Different as Other Counselor ImpairmentsCounselor Impairments

Countertransference (Ones’ Emotional Scrapbook): Countertransference (Ones’ Emotional Scrapbook): (Freud) unconscious absorption of the client’s issues (Freud) unconscious absorption of the client’s issues (Modern) symbolic experience of emotional self button-pushing; (Modern) symbolic experience of emotional self button-pushing;

Burnout : Burnout : - - ClassicalClassical (Freudenberger, 1974):(Freudenberger, 1974): a state of physical, emotional, a state of physical, emotional, and mental exhaustion; a negative shift in the way professionals and mental exhaustion; a negative shift in the way professionals view people they serve. view people they serve. - - ContemporaryContemporary (Maslach, [MBI]1982; 2003): 3 Factors- (Maslach, [MBI]1982; 2003): 3 Factors- cumulative emotional exhaustion (EE), depersonalizaiton (DP), cumulative emotional exhaustion (EE), depersonalizaiton (DP), feelings of a lack or reduced personal accomplishment (PA)feelings of a lack or reduced personal accomplishment (PA)Consequences: a loss of compassion, genuineness, and concern for Consequences: a loss of compassion, genuineness, and concern for the client/consumer. the client/consumer.

Comparing and Contrasting EFComparing and Contrasting EF

Compassion Fatigue (CF): Compassion Fatigue (CF): - - Nursing ProfessionNursing Profession (Joinson, 1992): a special type of (Joinson, 1992): a special type of burnout experienced by those working in high stress or burnout experienced by those working in high stress or high touch professions (trauma, loss of life).high touch professions (trauma, loss of life).- - Evolving ConstructEvolving Construct (Figley 1995; 2002; Stamm, et al.) (Figley 1995; 2002; Stamm, et al.)An An acute stressacute stress reaction or unhealthy form of reaction or unhealthy form of countertransference results from a state of emotional, countertransference results from a state of emotional, mental, and physical exhaustion. CF is both same and mental, and physical exhaustion. CF is both same and different BUT CF is acute-BO is not.different BUT CF is acute-BO is not.- - Secondary Traumatic StressSecondary Traumatic Stress (STS) Same as PTSD! (STS) Same as PTSD!

Professional Fatigue Syndromes: A Professional Fatigue Syndromes: A Concern for the Helping ProfessionsConcern for the Helping Professions

APAAPA - Advisory Committee on Colleague Assistance Impaired - Advisory Committee on Colleague Assistance Impaired Professionals.Professionals.

AMAAMA- Physician Impairment: “physical, mental, and behavioral - Physician Impairment: “physical, mental, and behavioral disorder that hinders the physician’s ability to safely treat disorder that hinders the physician’s ability to safely treat patients safely.”patients safely.”

American Nurses Association- “Compassion Fatigue”.American Nurses Association- “Compassion Fatigue”. ACA Task Force on Counselor Wellness and Impairment:ACA Task Force on Counselor Wellness and Impairment:- Educate counselors on prevention strategiesEducate counselors on prevention strategies- ID resources counselorsID resources counselors- Intervention and treatment recommendationsIntervention and treatment recommendations- Advocate for professional counseling associations to establish Advocate for professional counseling associations to establish

programs on counselor impairmentprograms on counselor impairment

Ethical Considerations in EFEthical Considerations in EF

“ “ Counselors are alert to the signs of impairment Counselors are alert to the signs of impairment from their own physical, mental, or emotional from their own physical, mental, or emotional problems and refrain from offering or providing problems and refrain from offering or providing professional services when such impairment is professional services when such impairment is likely to harm a client or others” likely to harm a client or others” (ACA; p. 9 Section (ACA; p. 9 Section C.2.g)C.2.g)

““Counselors shall seek assistance for problems Counselors shall seek assistance for problems that reach the level of professional impairment, and that reach the level of professional impairment, and if necessary, they limit, suspend, or terminate their if necessary, they limit, suspend, or terminate their professional responsibilities until such time it is professional responsibilities until such time it is determined they may be safe to resume their work” determined they may be safe to resume their work” (ACA; p. 9 Section C.2.g)(ACA; p. 9 Section C.2.g)

Epidemiology of Empathy Fatigue: Epidemiology of Empathy Fatigue: How is EF Experienced?How is EF Experienced?

Empathy and compassion is the foundation of counselor Empathy and compassion is the foundation of counselor pre-professional training pre-professional training (Rogers; Corey & Corey; Ivey & Ivey)(Rogers; Corey & Corey; Ivey & Ivey)

Intense interactions requires intense listening and Intense interactions requires intense listening and results in intense parallel experiences.results in intense parallel experiences.

Many counselors spend a tremendous amount of energy Many counselors spend a tremendous amount of energy trying to understand the meaning of their client’s exp.trying to understand the meaning of their client’s exp.

There’s a cost for counselors searching through their There’s a cost for counselors searching through their client’s emotional scrapbook looking for all the losses, client’s emotional scrapbook looking for all the losses, grief, pain, and suffering.grief, pain, and suffering.

Theoretical EF: Critical Theoretical EF: Critical PathwaysPathways

Counselors who use empathy-focus therapeutic Counselors who use empathy-focus therapeutic interactions may be more at risk for EF.interactions may be more at risk for EF.

EF is an unconscious process where the EF is an unconscious process where the professional and those around them may not professional and those around them may not recognize counselor fatigue.recognize counselor fatigue.

• EF can occur early-on developmentally in EF can occur early-on developmentally in supervisees due to pre-existing personality supervisees due to pre-existing personality traits, general coping resources, age, counselor-traits, general coping resources, age, counselor-developmental factors, opportunities in clinical developmental factors, opportunities in clinical experiences to build resiliency, organizational, experiences to build resiliency, organizational, and environmental supports.and environmental supports.

EF is cumulative and ranges on a continuum of EF is cumulative and ranges on a continuum of low, moderate, and high levels of physical-low, moderate, and high levels of physical-emotional-mental spiritual, and occupational emotional-mental spiritual, and occupational exhaustion. Can be both acute and cumulative.exhaustion. Can be both acute and cumulative.

Theoretical Empathy FatigueTheoretical Empathy Fatigue

EF (is much like stress) can be experienced EF (is much like stress) can be experienced by the pre-professional & professional as by the pre-professional & professional as both an acute, chronic, delayed onset both an acute, chronic, delayed onset reaction ranges on a continuum.reaction ranges on a continuum.

EF experienced by person dealing with a EF experienced by person dealing with a variety of issues- client’s daily hassles, variety of issues- client’s daily hassles, stress, grief, loss, addictions, or trauma.stress, grief, loss, addictions, or trauma.

Cumulative effects of EF leads to higher Cumulative effects of EF leads to higher levels of the deterioration in the pre-levels of the deterioration in the pre-professional counselor’s coping abilities and professional counselor’s coping abilities and resiliency.resiliency.

Consequences of Empathy Consequences of Empathy Fatigue? Fatigue?

- - Depletion of the counselor’s interpersonal Depletion of the counselor’s interpersonal effectiveness effectiveness

- Reduced warmth, compassion, intuitiveness - Reduced warmth, compassion, intuitiveness - Physiological type of chronic fatigue- Physiological type of chronic fatigue- Social and Peer-professional withdrawal- Social and Peer-professional withdrawal- Lack of mental focus- Lack of mental focus- Decreased meaning in one’s career - Decreased meaning in one’s career - Existential confusion- Existential confusion- Loss of connection with spiritual or religious practices- Loss of connection with spiritual or religious practices- Parallel experience with client living life out of balance- Parallel experience with client living life out of balance

Philosophy of EFPhilosophy of EF

It is not necessarily the nature of the client’s It is not necessarily the nature of the client’s stress, trauma, loss, grief, daily hassles, stress, trauma, loss, grief, daily hassles, unhealthy coping, or disability adjustment issues unhealthy coping, or disability adjustment issues that creates a sense of EF; rather, it is the that creates a sense of EF; rather, it is the counselor’s perception towards that particular counselor’s perception towards that particular client the counselor’s attributes that determines client the counselor’s attributes that determines the professional’s response to it; As a the professional’s response to it; As a consequence, leads to a diminished capacity to consequence, leads to a diminished capacity to listen, respond empathically, and provide listen, respond empathically, and provide competent professional services…overall effects competent professional services…overall effects on M-B-S.on M-B-S.

What Are EF Risk Factors?What Are EF Risk Factors?

Personality TraitsPersonality Traits History of MH ProblemsHistory of MH Problems Maladaptive Coping Behaviors Maladaptive Coping Behaviors Age and Experience-Related FactorsAge and Experience-Related Factors Organizational FactorsOrganizational Factors Job Duties within the OrganizationJob Duties within the Organization Socio-Cultural FactorsSocio-Cultural Factors Person’s Response to Past EventsPerson’s Response to Past Events Level of SupportLevel of Support

Global Assessment of EF Rating Scale:Global Assessment of EF Rating Scale:A Theoretical MeasureA Theoretical Measure

Theoretical scale:Theoretical scale: ranging from ranging from

Level 5(H-EF) – Level 1(L-EF).Level 5(H-EF) – Level 1(L-EF). Constellation of States, Traits, Behavioral Constellation of States, Traits, Behavioral

Dimensions:Dimensions: Cognitive; Behavioral; Spiritual; Cognitive; Behavioral; Spiritual; Process Skills; Emotional; Physical; Occupation.Process Skills; Emotional; Physical; Occupation.

Suggested use:Suggested use: Self-ratings; Ratings by clients; Self-ratings; Ratings by clients; Independent peer-observer; Independent Independent peer-observer; Independent researcher.researcher.

What are Counselors’ Experience of EF?What are Counselors’ Experience of EF?

Think back to the Think back to the earliest memoryearliest memory in in your career as a professional your career as a professional counselor. What did you experience counselor. What did you experience (physically, emotionally, cognitively, (physically, emotionally, cognitively, spiritually, existentially, and spiritually, existentially, and occupationally)- early-on; after a occupationally)- early-on; after a difficult client session- or difficult day difficult client session- or difficult day in your particular setting?in your particular setting?

Counselors’ Experience of EFCounselors’ Experience of EF

Please discuss some of your Please discuss some of your more recent client more recent client sessionssessions (within the last month). What did you (within the last month). What did you experience (physically, emotionally, cognitively, experience (physically, emotionally, cognitively, spiritually, existentially, and occupationally); spiritually, existentially, and occupationally); after a difficult client session- or difficult day in after a difficult client session- or difficult day in your particular job setting?your particular job setting?

Exploring Counselor’s Coping & ResiliencyExploring Counselor’s Coping & Resiliency

After all you have experience (personally and After all you have experience (personally and professionally) working as a professional professionally) working as a professional counselor – what are some things that you could counselor – what are some things that you could share with new professional just entering the share with new professional just entering the helping profession (in terms of day-to-day issues helping profession (in terms of day-to-day issues or some of the more very difficult client issues)?or some of the more very difficult client issues)?

Please discuss any specific coping or resiliency Please discuss any specific coping or resiliency strategies you have developed over your career.strategies you have developed over your career.

EF Assessment for Counselor EF Assessment for Counselor Supervisors: Share Your Supervisors: Share Your

ExperiencesExperiences1.1. I chose the field/occupation of counseling because…I chose the field/occupation of counseling because…2.2. I work best with clients who are…I work best with clients who are…3.3. I feel good and am encouraged by my client’s success I feel good and am encouraged by my client’s success

when they…when they…4.4. I am most negatively affected by my clients who…I am most negatively affected by my clients who…5.5. My needs are met when they…My needs are met when they…6.6. I generally do not work well under conditions that I generally do not work well under conditions that

involve…involve…7.7. If I could make any change(s) in my situation I would… If I could make any change(s) in my situation I would…

Ethical Review Checklist for Ethical Review Checklist for Counselor SupervisorsCounselor Supervisors

Does the Supervisee:Does the Supervisee:1.1. Have the necessary and sufficient skills Have the necessary and sufficient skills

and competencies to provide services to and competencies to provide services to clients/consumers at least provisionally?clients/consumers at least provisionally?

2.2. Possess training that has reached an Possess training that has reached an acceptable level of competency in the acceptable level of competency in the specialty area that they practice?specialty area that they practice?

3.3. Have the ability to control or cope with the Have the ability to control or cope with the personal, emotional, psychological stress of personal, emotional, psychological stress of their job?their job?

4.4. Possess enough self-awareness to limit or Possess enough self-awareness to limit or suspend their practice when they are at suspend their practice when they are at risk for EF?risk for EF?

Resilient ProfessionalsResilient Professionals Convey a sense of genuine commitment and confidence to help Convey a sense of genuine commitment and confidence to help

with their client’s stress levels and critical issues- despite dealing with their client’s stress levels and critical issues- despite dealing with one’s own level of life difficulties; with one’s own level of life difficulties;

Communicate competence and have a good sense of mastery Communicate competence and have a good sense of mastery with handling challenging and difficult clients- without depletion with handling challenging and difficult clients- without depletion of one’s own mind, body, and spirit;of one’s own mind, body, and spirit;

Feel optimistic, positive, and energetic about the good work they Feel optimistic, positive, and energetic about the good work they do and have good coping resources- even in tough times;do and have good coping resources- even in tough times;

Have a purpose-driven life, find meaning in their profession and Have a purpose-driven life, find meaning in their profession and practice good self-care techniques;practice good self-care techniques;

Maintain excellent interpersonal insight and still have the Maintain excellent interpersonal insight and still have the capacity for warmth, caring, and empathy.capacity for warmth, caring, and empathy.

The Resiliency AdvantageThe Resiliency AdvantageDr. Al SiebertDr. Al Siebert

1. Making conscious choices in life.1. Making conscious choices in life.2. Power of Positive Thinking.2. Power of Positive Thinking.3. Take responsibility.3. Take responsibility.4. Internal locus of control.4. Internal locus of control.5. Self motivate yourself.5. Self motivate yourself.6. Don’t fear trying-out new things.6. Don’t fear trying-out new things.7. Take control of your life.7. Take control of your life.8. Practice positive approaches to life.8. Practice positive approaches to life.

Adaptive Coping & Healing Adaptive Coping & Healing Strategies: OrganizationalStrategies: Organizational

• Skilled & Competent clinical supervisionSkilled & Competent clinical supervision• Mentoring approachesMentoring approaches• Peer-supervisionPeer-supervision• Shift focus of treatment team meetingsShift focus of treatment team meetings• Re-structure organizational philosophy Re-structure organizational philosophy

to a healthy person-centered {M-B-S}to a healthy person-centered {M-B-S}

Show-upShow-up

Pay AttentionPay Attention

Be Open to the OutcomesBe Open to the Outcomes

Wellness ApproachesWellness Approaches

BreathingBreathing

MeditationMeditation

VisualizationVisualization