Compassion Fatigue Solutions

This week, I would like to offer you an article I recently wrote for my professional association's newsletter. It is currently being considered for publication.

Compassion fatigue (CF) is characterized by deep emotional and physical exhaustion and by a shift in a helping professional’s sense of hope and optimism about the future and the value of their work. It has been called “a disorder that affects those who do their work well” (Figley 1995) The level of CF a helper experiences can ebb and flow from one day to the next, and even very healthy helpers with optimal life/work balance can experience a higher than normal level of compassion fatigue when they are overloaded, are working with a lot of traumatic content, or find their case load suddenly heavy with clients who are all chronically in crisis.

The best strategy to mitigate the impact of Compassion Fatigue is to develop excellent self care strategies, as well as an early warning system that lets the helper know that they are moving into the caution zone of CF.

If would you like to assess your current level of Compassion Fatigue, visit Dr Beth Stamm’s website and take the compassion fatigue self-test: www.isu.edu/~bhstamm/tests.htm. This test not only looks at CF, it also assesses helpers’ level of compassion satisfaction which is “the pleasure you derive from being able to do your work well.” (Stamm, 1999)

For the past 7 years, I have been working as a compassion fatigue specialist, offering training and counseling to helpers through workshops and individual counseling work. Here are some of the top strategies that workshop participants have identified as being most protective:

1.Take Stock: Check-in with yourself on a regular basis. I have my clients draw a dinner plate on a piece of paper and list every demand/commitment/concern they currently carry with them inside the plate. Then, I ask them to identify the demands that may be changeable, even by one percent. Participants often comment that they rarely take the time to take stock, let alone try to identify areas where improvement is possible. This can become an important and useful tool in monitoring your level of work and home stress.

2. Find time for yourself every day: Whether it’s 5 minutes or one hour, time for yourself allows you to regroup and refuel. Aim to rebalance your workload if you can, by spreading out your most challenging clients, or having short breaks between sessions to take a walk, do some paperwork, talk with colleagues or visit a fun, non-work related website.

3. Have a transition from work to home: Aim to leave work behind and start fresh at home. This can mean changing out of your work clothes when you get home, walking twice around the block before walking into your house or some other mindful ritual that allows you to transition and leave the work-related worries and difficult stories back at work, where they belong.

4. Learn to say no (or yes) more often: Many helpers tell me that they realize they now say no to friends and family all the time as they feel too tired or depleted to give any more. Others say that they are caregivers in all aspects of their lives, and walk in the door from work only to get phone calls from family members in need, or a pager from work or from the numerous committees they are on. Explore ways to set better limits at work or with demanding family members or friends or, conversely, try to say “yes” to something each week that is time-limited. Learning to set limits is a key tool in optimal self care.

5. Assess your Trauma Inputs: Do you read about, see photos of, and are generally exposed to difficult stories and images at your work? Take a trauma input survey of a typical day in your life. Starting with the moment you get up in the morning, note how many traumatic images and stories you absorb through the media, newspaper and/or radio. Now look at your work. Not counting direct client work, how many difficult stories do you hear, whether it be in a case conference, around the water cooler, debriefing a colleague, or reading files? Now look at your return trip home. Do you listen to the news on the radio? Do you watch TV at night? What do you watch? If you have a spouse who is also in the helping field, do you talk shop and debrief each other? There is a lot of extra trauma input that we do not need to absorb or to hear about. We can create a “trauma filter” to protect ourselves from this extraneous material. This requires mindfulness and an awareness of what is coming at us.

And a few more strategies…

-Attend Workshops/Professional Training Regularly: Further professional development has been identified as one of the top protective factors against CF by researchers in the field. It makes sense: the more competent and confident we feel doing our work, the less stressful the work is, and the less depleted we become.

-Consider Joining a Supervision/Peer Support Group: This can be very informal and involve only two or three colleagues or friends. Debriefing and connecting with others is a significant way to protect ourselves from burnout and compassion fatigue.

-Consider working part time (at this type of job): It has been found that the optimal number of days of doing direct client work is three days per week. If you would like to investigate ways to make this financially possible, there are some excellent books on this topic, such as Your money or your life by Joe Dominguez and Marsha Sinetar’s Do what you love and the money will follow. You can also explore the possibility of job sharing direct client work and taking on other duties that feel complementary and interesting to you on the other two days.

-Learn more about Compassion Fatigue and Vicarious Trauma: Read books (see below), visit websites and attend educational sessions on CF and VT. Workshops can be validating experiences where you meet other helpers and learn new strategies.

-Start small: You may not notice it right away, but making one small change to your daily routine can have tremendous results in the long term. Imagine if you started walking up two flights a stairs per day instead of using the elevator, what might happen after three months?

Recommended books on Compassion Fatigue and Vicarious Trauma:

Figley, C.R. (Ed.). (1995) Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Saakvitne, K.W.; Pearlman, L. A., & the Staff of the Traumatic Stress Institute (1996): Transforming the pain: A workbook on vicarious traumatization. New York: W.W. Norton.

Stamm, B.H. (Ed.). (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators, 2nd Edition. Lutherville, MD: Sidran Press.

Self-Care books for Helpers:

Borysenko, J. (2003) Inner peace for busy people: 52 simple strategies for transforming your life.

Fanning, P. & Mitchener, H. (2001) The 50 best ways to simplify your life

O’Hanlon, B. (1999) Do one thing different: 10 simple ways to change your life.

Posen, D. (2003) Little book of stress relief.

Richardson, C. (1998) Take time for your life.

SARK, (2004) Making your creative dreams real: a plan for procrastinators, perfectionists, busy people, avoiders, and people who would rather sleep all day.

Weiss , L. (2004) Therapist’s Guide to Self-care.