Compassion Fatigue: What’s New? What Works?. Françoise Mathieu, M.Ed., CCC. Certified Canadian Counsellor & Compassion Fatigue Specialist. www.compassionfatigue.ca. •Background: Robin Cameron. www.compassionfatigue.ca. My amazing team. Diana Tikasz, MSW RSW Hamilton.
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Françoise Mathieu, M.Ed., CCC.
Certified Canadian Counsellor & Compassion Fatigue Specialist
Diana Tikasz, MSW RSW
Rebecca Brown, MSW RSW
Lori Tomalty-Nusca, ECE
Meaghan Welfare, BA
•Walking the Walk CF workshop has been offered to thousands of Canadians across the country
•Nurses, social workers, MH counsellors, PSWs, teachers, physicians, allied health professionals, victim service workers, court reporters, lawyers, judges, ministers, chaplains, police officers, paramedics, prison staff, alzheimers societies, palliative care…
•Approx 300 CF Educators trained through Train the Trainer program
•Various organizations implementing CF education as part of their staff wellness plan (Peel Region, York Region, Bruyere Continuing Care, Yukon and NWT Victim Services, to name a few).
•Now: more attention being given to organizational health and how agencies can help reduce/prevent CF-VT
•Deeply compromised system
•Ongoing challenges and cutbacks
•Increasingly complex cases (even in schools, end of life care…)
•Big org health assessment – interviewed all staff individually. What came out? Who coped well and who didn’t?
Published by Routledge - December 2011
•A profound and gradual emotional and physical exhaustion that helping professionals and caregivers can develop over the course of their career.
•An erosion of all the things that keep us connected to others in our caregiver role: our empathy, our hope, our ability to tolerate strong emotions/difficult stories in others, and of course our compassion - not only for others but also for ourselves.
•Changes in our personal and professional lives: we become dispirited and increasingly bitter at work, contribute to a toxic work environment, more prone to clinical errors, violate client boundaries, lose a respectful stance towards our clients. short-tempered with our loved ones and feel constant guilt or resentment at the never ending demands on our personal time.
•Can also happen to caregivers (“caregiver fatigue”)
•Repeated exposure to difficult stories changes our view of the world.
•Can cause nightmares, difficulty getting rid of certain images, an intense preoccupation with a particular story or event we’ve been exposed to.
•”When external trauma becomes internal reality”
Lipsky 2009 “Impacts the entire nervous system”
•Can happen through work (stories we are told or stories we read) and through media exposure.
•Accumulates over time & across clients.
•Both CF and VT are occupational Hazards
• 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)
accidents, fatalities involving children
“[…] happens when there are inconsistencies between a [helper’s] beliefs and his or her actions in practice” (Baylis 2000)
Najjar, Nadine et al (2009) Journal of Health Psychology, Vol 14(2) 267-277.
•Depending on the studies, 40-85% of health care professionals were found to have CF and/or high rates of STS
•57% of SW have been threatened, 16 % physically assaulted
•40% of nurses physically assaulted
•52% military chaplains at medium to high risk for anxiety and depressive disorders - this is twice as high as the norm for CF members and higher than general population
2009 AMA study of junior doctors
•54% met the criteria for CF
•69% met the criteria for burnout
•71% had lower than average levels of job satisfaction
Markwell & Wainer, Doctors’ Health, MJA Vol 191, No 8, 19 Oct 2009
•2005 survey of the health of nurses (Canada):
8/10 nurses had accessed their EAP which is over twice as high as the EAP use by the total employed population
•DV lawyers: significantly higher levels of STS and burnout compared to other mental health providers
•2011 study of US surgeons had thought about suicide 1.5-3 times more than the general population. Only 26% of them had sought psychological help for their SI.
•US immigration judges higher levels of burnout than hospital physicians and prison wardens
•59% of MH professionals are willing to seek help vs 15% of law enforcement professionals
First, do no harm to yourself in the line of duty when helping/treating others
Second, attend to your physical, social, emotional and spiritual needs as a way of ensuring high quality services for those who look to you for support as a human being
1) SOCIAL SUPPORT IN THE WORKPLACE
"the most significant factor associated with compassion satisfaction” (Killian 2008 study of trauma counsellors)
2) TRAINING ON SELF CARE AND SELF AWARENESS
"[...] most of the therapists interviewed observed that they had not had any courses or specific training on professional self-care, and this was an important but neglected area in training.” Killian 2008
Killian, K.D. Helping Till it Hurts? A Multimethod Study of Compassion Fatigue, Burnout, and Self-Care in
Clinicians Working With Trauma Survivors in Traumatology, Vol 14, No 2, June 2008.
Dr Gabor Maté
Long term effects of chronic stress
•“Our immune system does not exist in isolation from daily experience.” (Maté, 2003, p.6)
The “Gut” Feeling
Maté, 2003 p36
•Research on the effectiveness of MBSR is highly conclusive:
over 25 year of studies clearly demonstrate that MBSR is
helpful in reducing emotional distress and managing severe
•MBSR has been used successfully with patients suffering from chronic pain, depression, sleep disorders, cancer-related pain and high blood pressure. (Cohen-Katz et al, 2005)
•Based at Toronto's CAMH, Zindel Segal has developed a mindfulness-based cognitive therapy program for treating depression that has shown to be highly effective
•MBSR and Compassion Fatigue: www.compassionfatigue.ca
3) Rebalancing Caseload & Workload Reduction"To combat compassion fatigue and burnout, agency administrators and therapists may also wish to ask themselves "How many cases are too many? ” Killian, 2008
What works? Con’t
4) Limiting Trauma Inputs
•Limiting media exposure/traumatic stories
•Low Impact Debriefing aka “sliming”
see my website for an article describing this process:
Low Impact Debriefing
2009 Duxbury report on role overload in health care:
Step Five Con’t: Improved Work-Life Balance
Help for the Helper: the psychophysiology of compassion fatigue and vicarious trauma
•Increased recognition that this is an organizational health concern (CSST report Summer 2007, Mental Health at Works CMHA and Desjardins)•The bottom line: high attrition, poor retention, soaring costs of LTD and sick leave
A changing landscape,
for the better
• Feeling wronged & bitter: A sense of helplessness, of persecution
Laura van Dernoot Lipsky (2009) Trauma Stewardship
Talking to my neighbours
Hiding from neighbours