Care for the Caregiver: Addressing Compassion Fatigue

1. Care for the Caregiver: Addressing Compassion Fatigue EZ Glide Chairs for vertical Marsha I. Wiggins, Ph.D. Licensed Marriage & Family Therapist # MT2567 Kaleidoscope Counseling & Consulting, LLC (561) 247-COPE (2673) West Palm Beach, FL www.westpalmbeachcounselor.com

2. Objectives: • At the end of this workshop you will be able to: • Verbalize the Compassion Fatigue syndrome and the signs and symptoms of Compassion Fatigue. • Discuss ways of prevention and overcoming of Compassion Fatigue

3. Biblical Bases for Compassion • In the Hebrew scriptures the term, “hamal” means to have pity, to spare, to have compassion as with Pharoah’s daughter taking responsibility for baby Moses (Exodus 2:6) • “Raham” means to love deeply to have mercy

4. Biblical Bases for Compassion • In the Christian Testament, • “Eleos” means mercy, an emotion aroused by contact with a person who is suffering, accompanied by giving help • Luke 6:36: “Be merciful, just as God is merciful.”

5. Biblical Bases for Compassion • Oiktirmos—mercy or compassion, torn of heart at the sight of another’s suffering • The Lord is full of compassion and mercy (James 5:11) and believers are urged to put on a heart of compassion (Colossians 3:12-13) (Richards, L. O. (1991). Expository Dictionary of Bible Words. Zondervan)

6. Application • To express compassion is to imitate God’s mercy and compassion (Luke 6:36) • To convey compassion is accomplished by reliance upon God as the branch draws energy from the vine (John 15:4-5)

7. Exactly What Is Compassion Fatigue? • Defined as “State of exhaustion and dysfunction (biologically, psychologically and socially, spiritually) as a result of prolonged exposure to secondary trauma or a single intensive event. (C.R. 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 who were primarily traumatized.

8. Compassion Fatigue In Many Forms • Healthcare Professions • Physicians, Nursing, Social Services, Mental Health Providers • Other Helping Professions • Teachers, Clergy, Attorneys, Disaster Site Clean-up Crews, Animal Shelter staff etc. • Fire, EMS, Law Enforcement • Family Care Givers • Charitable Giving workers • Animal rescue workers (Philpot, Sue)

9. Menu of Misconceptions that Lead to Compassion Fatigue • “I will ‘fix’ the problem…make everything OK…save the world.” • “ I am responsible for outcomes.” • “If I care enough, everything will be OK.” • The hurting people I help will appreciate everything I do for them.”

10. More myths… • “I will have enough resources (time money, material, skills, training) to fix things.” • “Significant people in my life will support and approve my absence from this relationship while I invest in this compassionate mission.” • “I know what I’m getting into.”

11. And other myths… • “ I can do it alone.” • “If I’m spiritual enough, I can deal with the stress of working with suffering people.” (Wood, Samuel)

12. The Compassion Fatigue Trajectory Becoming a victim of Compassion Fatigue follows a predictable pattern of 5 phases: 1. ZEALOT PHASE 2. IRRITABILITY PHASE 3. WITHDRAWAL PHASE 4. ZOMBIE PHASE 5. VICTIMIZATION

13. ZEALOT PHASE • In the Zealot Phase caregivers… • Committed, involved, available • Solving problems/making a difference • Willing to go the extra mile • High enthusiasm • Volunteers without being asked

14. IRRITABILITY PHASE • In the Irritability Phase caregivers… • Begin to cut corners • Begin to avoid clients • Begin to mock co-workers and clients • Begin to denigrate the people they serve • Use inappropriate humor • Make mistakes • Distance selves from friends & co-workers

15. ZOMBIE PHASE • In the Zombie Phase caregivers… • Hopelessness turns to rage • Begin to hate people…any/all people • Judge others as incompetent or ignorant • Develop a disdain for clients • Lose patience, sense of humor, time for fun

16. VICTIMIZATION • In this phase, caregivers… • Become overwhelmed and consider leaving their profession or volunteer posts • Experience physical illnesses • Have perpetual symptoms (Wood, Samuel)

17. A Model of Stress & Coping • McCubbin & McCubbin (1989) found: • Resources + Pile Up of Demands + Perceptions • Influences the way people respond to a major stressor. • Also, the level of adaptation to stress is also based on individuals’ resources ($, social/family support, spirituality etc.), Pile Up of Demands (a laundry list of other stressors) and Perceptions (how individuals view and make sense of their life circumstances)

18. The Process

19. Why Not “Burnout” • Defined as: “Exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration” (Merriam-Websters Collegiate Dictionary) • Gradually builds to a breaking point and the stress and frustration comes from all types of work-related stressors

20. Burnout • Usually takes longer • Compassion Fatigue may be a contributing factor • Frustrations such as • Paper work and “red tape/bureaucratic issues” • The environment (home and work) • Colleagues • Pace and or grind of work

21. Burnout • Burnout is losing all satisfaction at work as a result of long hours, too much stress, & overwork.

22. Compassion Fatigue vs. Burnout • Compassion fatigue is a debilitating weariness brought about by repetitive, empathic response to pain and suffering. With compassion fatigue, you are absorbing the trauma through the eyes and ears of your clients.

23. The Difference? Ask the Question: “Do I Love My Job?” Yes Compassion Fatigue NO Burnout (Philpot, Sue)

24. Who is More Likely to Develop Compassion Fatigue? • Anyone with the capacity for true compassion, empathy, concern and caring • We try to stay within professional boundaries and adhere to training guidelines • But the greatest strength (compassionate connection) is also greatest vulnerability • Not a characteristic to give up

25. Compassion Fatigue • Recognize the symptoms • Educate yourself • Recognize that: • The more prolonged exposure • Working long hours • More personal demands • More isolated you allow yourself to become Increases your vulnerability

26. Warning Signs and Symptoms • Symptoms similar to post-traumatic stress disorder (PTSD) but from secondary exposure • Additionally cynical, discouraged or hopeless attitude about work or career • Paradoxically you find it difficult to leave work at the end of the day • Have recurring thoughts about a particular case

27. Symptoms

28. Prevention • Early Recognition and Awareness is Key! • Restore a healthy balance in your life including: • Good sleep, good nutrition and exercise • Take Time Off From Work (mini-vacations) • Enhancing Your Skills by Attending Stress Reduction Courses • Enhanced Self Care Skills

29. Don’t Wear This Button

30. Resiliency: The Ability to Keep On Going When the Going Gets Tough • Must be well rested • Resiliency sags when you are tired • Utilize your positive supportive connections to process your feelings • Take negatives and turn them into positives • Research shows those who can “turn off thoughts about work” are more resilient during their careers

31. Stay Resilient • You need to have good support • You need to have the ability to talk about it • Be able to disconnect work and home • Strong connections with others

32. Overcoming Compassion Fatigue • PHYSICAL NEEDS: • Get medical treatment for those symptoms that are interfering with your daily functioning; • Eat meals at a relaxed pace • Develop and stick to an exercise plan • Don’t self-medicate with alcohol or drugs • Take time off! • Take time off!

33. Overcoming Compassion Fatigue • PHYSICAL (cont) • Practice breathing exercises • Breathe deeply: inhale, exhale • Imagine: go to your quiet place • Feel: tension leave, relaxation, healing come

34. Overcoming Compassion Fatigue • MENTAL NEEDS: • Assess what’s on your plate. Make a list of your stressors to see what is making your plate too full. • Reduce or eliminate multi-tasking. • Identify stressful thinking (e.g. “always,” “never” “should” “ought” • Reframe failures as mistakes

35. Overcoming Compassion Fatigue • MENTAL NEEDS (cont) • Notice the connection between thoughts, feelings and behaviors

36. Overcoming Compassion Fatigue A PERSISTENT THOUGHT IS LIKE A DROP OF DYE IN A BOWL OF WATER: IT COLORS YOUR PERCEPTION OF THINGS! (Endicott, Larry)

37. Overcoming Compassion Fatigue • WORK: • Rebalance your workload! Do you work through lunch? Spend weekends catching up? • Take mini-breaks • Do at least one nourishing activity a day • Ask for help • Have a transition from work to home

38. Overcoming Compassion Fatigue • WORK (cont) • Learn to say “no” more often. • Assess your trauma inputs and create a visualization or trauma filter to protect yourself from extraneous material.

39. Overcoming Compassion Fatigue • WORK (cont) • Create and/or enforce time off policies in the workplace! A dry well cannot quench thirst!

40. Overcoming Compassion Fatigue • RELATIONAL/EMOTIONAL • Create a self-care idea collection such as a walk on the beach, massage, watching sports on TV) • Plan time to connect with family and friends • Keep a feeling journal • Have one good con- versation a day

41. Overcoming Compassion Fatigue • SPIRITUAL “You are not made for the Sabbath; the Sabbath is made for you.” (Mark 2:27) “Sabbath is not dependent upon our readiness to stop. We do not stop when we are finished. We stop because it is time to stop.” (Muller, p 82)

42. Overcoming Compassion Fatigue • SPIRITUAL (cont) • Prayer & Meditation • Walk the Labyrinth • Be still • Be silent • Listen to music • Read

43. Overcoming Compassion Fatigue “Just as speech without silence creates noise, charity without rest creates suffering.” (Muller, p. 159)

44. Overcoming Compassion Fatigue From Isaiah 40: (paraphrase) God, the Creator of the ends of the earth does not become weary or tired. God gives strength to the weary and to whoever lacks might, God increases power.

45. All in all • Unrecognized and Untreated Compassion Fatigue causes people to • Leave Their Professions • Self Treat with Drugs or Alcohol • Become Suicidal or Self Destructive

46. Therefore, remember… • You are not God. • The need will always be greater than the resources. • Use care in how your measure success • Who you are is as important to the mission as what you do.

47. And this… • Their pain is not your pain. • Don’t take them home with you. • Care for your spirit, emotions, and body so that there will be something left to give. (Wood, Samuel)

48. Be Sabbath for One Another We can make our minds so like still water that beings gather about us, that they may see their own images, and so live for a moment with a clearer, perhaps even a fiercer life, because of our quiet. (Yeats)

49. Questions?

50. References Figley, C. (1995). Compassion Fatigue:Coping with secondary traumatic stress disorder in those who treat the traumatized. London: Brunner-Routledge. Muller, W. (1999). Sabbath: Restoring the sacred rhythm of rest. NY: Bantam. Power point slides based on work by Larry Endicott, Sue Philpot, Samuel Wood)