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The Price of Caring: Compassion Fatigue, Secondary Trauma and Burnout

9/16/2019

Copyright © 2019. All rights reserved. 1

The Price of Caring

Compassion Fatigue, Secondary Trauma and Burnout

Julia Yeary, LCSW, IMH-E®

[email protected] of Military Family Resources

ZERO TO THREE

ZERO TO THREE

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We are a national, nonprofit organization that informs, trains and supports professionals, policy makers and parents in their efforts to improve the lives of infants and toddlers.

• We train professionals and build networks of leaders

• We influence policies and practice

• We raise public understanding of early childhood issues

All our work is:• Grounded in research and experience• Multi-disciplinary• Culturally responsive

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mailto:[email protected]


9/16/2019


Our Objectives

• Understand how our work with families might affect us physically, emotionally, and spiritually

• Consider the role of transference and countertransference in home visiting

• Define burnout, secondary trauma, vicarious trauma and compassion fatigue

• Explore ways we can mindfully practice self-care

Copyright ©2019. All rights reserved.

All emotions are contagious—both the ones that are

pleasant and the ones that are unpleasant.

Rothschild, 2006

Photo by Photodune


YOU are unique

What is YOUR story?

– What are your strengths?

– What ghosts do you carry with you?

– What angels do you carry with you?

Photo by Kiwi Street Studios


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How We Are Matters!

Our empathy is our major, greatest, and most reliable tool.

Photo by Jaclyn Yeary


We Are Not a Blank Slate

• Freud wanted his clinicians to be a blank slate so clients could project feelings from past experiences onto the analyst. This is what traditionally was known as “Transference“

• Freud came to understand we are ALL stirred by the experiences we hear and see when faced with all the emotions brought forward by our client families. He called this process “Counter-transference”

Rothschild, 2006

Photo by Photodune


We Experience Feelings As We Hold Our Clients

Today, practitioners understand counter-transference may help a home visitor to have empathy, or clues to understanding what is going on with the client family.

While there are many definitions for counter-transference, we will define it as:

“the practitioner’s reactions to his client that have roots in his own past.”


Rothschild, 2006


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Let’s Reflect

How have you used empathy to help build a trusting relationship with your client families?

Were there times when you carried the family’s story home with you, or found yourself thinking about a past incident in your life after a visit with a family?


Blurred Boundaries

When “their” story is “your” story…

Photo by Jaclyn Yeary


Empathy

Retrieved from http://www.dictionary.com/browse/empathy?s=t

[em-puh-thee]

Noun1. The psychological identification with or vicarious

experiencing of the feelings, thoughts, or attitudes of another

“I know how you feel”


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http://www.dictionary.com/browse/empathy?s=t


9/16/2019


How Do We Show Our Empathy?

• We lean in to hear what they have to say

• We match our expression to their expression

• We imagine what it might be like

• We work to understand their experience


Empathy2

• Damasio differentiated emotion, or all things body--sensations, autonomic and somatic muscular changes, movement and feeling--or the label that describes the summation of these body states.

• Ekman confirmed Darwin’s theory that each feeling has a specific, observable somatic manifestation including one’s facial expression and body posture.

• Elaine Hatfield and colleagues at the University of Hawaii studied emotional contagion. She noted the body is central to emotion contagion.

• How our bodies respond through mirroring or mimicry when we empathize to create similar body experiences as the object of our empathy, or the same emotions.

Rothschild, 2006


Triggers

Empathy may also trigger our memories of previous traumatic experiences, our ghosts that we carry with us.

These awakened memories may be re-experienced in our bodies in a way that is different than our normal memories

– Normal memories are organized with a beginning, middle and end.

– Traumatic memories are disorganized and include details that are sometimes too clear—smells, images, sensations while leaving out other details such as sequencing. Van Der Kolk, 2014



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Graphic with permission from Mellow Doodles and Time to Change

The Definitions

• Compassion Fatigue, introduced by Figley, is applied to anyone who suffers as a result of serving in a helping capacity.

• Burnout is reserved for those whose health is suffering or whose outlook on life has turned negative due to workload or type of work done.

• Primary Trauma is the result of a traumatic incident with a clear victim of that incident (including loss of a relative or close friend from that incident, etc.)

• Secondary Trauma is usually reserved for those who witness trauma, becoming overwhelmed by what is seen or heard. It is a direct experience of witnessing.

• Vicarious trauma is used for those who are impacted by working with traumatized individuals in the workplace.

Rothschild, 2006, p. 14-15


Vicarious Trauma

• Even though the home visitor was not involved directly in the traumatic incident, the home visitor vicariously feels the experience in her nervous system.

• It is a sign that a client’s history is having an extreme effect on the home visitor



Rothschild, 2006

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Compassion Fatigue

• Those in the helping field know that compassionate work can lead to exhaustion

• Use of self and the use of empathy may result in the emotional sensations residing in the helper’s body


Rothschild, 2006

Photo by Photodune

Burnout

Disengaged

• feelings of energy depletion or exhaustion, increased mental distance from one’s job … and reduced professional efficacy

• deeply dissatisfied and describe their experience akin to depression (feeling helpless, hopeless, worthless)

Engaged

• depleted (exhausted, overworked), have a love/hate relationship with work (love it and feel fulfilled, but can also hate it and be upset at work), and experience a lack of support at work (feel annoyed, unappreciated)

Pringle, Stern, & Moeller, 2019


How Much Can We Hold?

SuperVisitor

My own stuff

My family’s

stuff

My client’s

stuff


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The Ethical Imperative of Self-Care

• Cannot build relationships or trust without empathy

• We know the importance of parallel process: as we are with families, they will be with their children.

• We are our primary tool in our work with families. We cannot do our best work if our primary tool isn’t functioning at capacity. Derrick, 2016


Self-Care As Buffer

A reflective attitude about one’s personal well-being can help the [home visitor] identify early signs of burnout, vicarious trauma, or compassion fatigue.

Lieberman, Ghosh Ippen, and Van Horn, 2015, p. 48


Balancing Our Needs with the Work


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“If providers prioritize self-care, they are giving two gifts—one to themselves and one to the children in their care.”

Rice & Groves, (2005, p. 49)

Reflection

Relationships

SleepHealthy Eating

Exercise

Self-Talk

What do you do to practice self-care?

Reflection in Action

Flexible Response Seibel, N., Britt, D., Gillespie, L., and Parlakian, R. (2006)


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Reflective Supervision

Reflective supervision is a collaborative relationship for professional growth that improves quality and practice by cherishing strengths and partnering around vulnerabilities to generate growth.

What might this look like in your work setting?

Shahmoon-Shanok, 1991 in Scott Heller & Gilkerson, ed, 2009


Collaboration

• Having a partner in the work and in the reflection

• “You are not alone. We’re in this together.”

Seibel, N., Britt, D., Gillespie, L., and Parlakian, R. (2006)

Photo by iStockphoto-Photohamster


Professional Boundaries

How do boundaries promote professional self-care?


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Mindfulness

Staying in the moment and focusing on the here and now while practicing ways to act in a non-judgmental fashion…mindfulness meditation bolsters a healthier way to cope with life’s daily struggles.

Dattilio, 2015p p. 396-397


A Mindful Minute

“We are not invulnerable, but if we maintain a strong sense of community among ourselves, we can be resilient.” (Catherall, 2008) P

hoto

by Jaclyn Y

eary


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ReferencesCatherall, D. (2008). Secondary stress and the professional helper. Georgia Department of Community Health. Retrieved 1/10/2011 from http://www.georgiadisaster.info/MentalHealth/MH16%20SecondaryStress/Secondary%20Stress%20and%20the%20Professional%20Helper.pdf

Dattilio, F. M. (2015). The Self-Care of Psychologists and Mental Health Professionals: A Review and Practitioner Guide. Australian Psychologist, 50(6), 393-399.

Derick, L. (2016). The interplay of ethics and self-care: Compassion for self, compassion for others. Massage Magazine, 244, 64-67.

Liebermann, A.F., Ghosh Ippen, C., & Van Horn, P. (2015). Don’t hit my mommy! A manual for Child-Parent Psychotherapy with young children exposed to violence and other trauma. Washington DC: ZERO TO THREE.

Pringle, Z., Stern, R., & Moeller, J. (2019). The truth about burnout: It doesn’t look how we expect it to. The Hill. Retrieved from https://thehill.com/opinion/healthcare/458906-the-truth-about-burnout-it-doesnt-look-how-we-expect-it-to.

. Sep2016, Issue 244, p64-67. 4p.


References

Rice, K. F., & Groves, B. M. (2005). Hope and healing: A caregiver’s guide to helping young children affected by trauma. Washington, DC: ZERO TO THREE.

Rothschild, B. (2006). Help for the helper: The psychophysiology of compassion fatigue and vicarious trauma. New York: Norton.

Scott Heller, S., & Gilkerson, L. (Eds.). (2009). A practical guide to reflective supervision. Washington, DC: ZERO TO THREE.

Seibel, N., Britt, D., Gillespie, L., and Parlakian, R. (2006). Preventing child abuse and neglect: Provider-parent partnerships in child care. Washington, DC.

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books.


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http://www.georgiadisaster.info/MentalHealth/MH16%20SecondaryStress/Secondary%20Stress%20and%20the%20Professional%20Helper.pdf

https://thehill.com/opinion/healthcare/458906-the-truth-about-burnout-it-doesnt-look-how-we-expect-it-to

the price of caring - georgetown university center for ... price of caring ppt.pdfderick, l. (2016)....

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