Reducing Compassion Fatigue, Secondary Traumatic Stress, and Burnout

A Trauma-Sensitive Workbook

William Steele

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429615146
• Edition: 1
• Topic: Psicologia
• Subtopic: Disturbo Post-Traumatico da Stress (DPTS)

This workbook addresses the vital questions helpers, responders, and organizations have about self-care and its relationship to resilience and sustained effectiveness in the midst of daily exposure to trauma victims and or situations.

Packed with activities, worksheets, and interactive learning tools, the text provides neuro-based and trauma-sensitive recommendations for improving the ways clinicians care for themselves. Each 'session' helps clinicians identify their personal self-care needs and arrive at an effective self-care plan that promotes resilience in the face of daily exposure to trauma-inducing situations and reduces the effects of compassion fatigue and burnout.

Reducing Compassion Fatigue, Secondary Traumatic Stress, and Burnout is an essential workbook for any helper or organization looking to enhance compassionate care.

1 You Are Not Alone

Pre-session Questions and Activities

Before reading Session One, answer the following questions and complete the activities. Your answers can then be compared with those detailed in this session.

Pre/post-session questions and worksheets in the Appendix may be photocopied and/or downloaded from www.routledge.com/9780367144098

Answer all questions as best you can. If you seem to have no answer, give it your best effort as this will help reinforce what is learned throughout this session.

Questions

1. Define the major difference between CF, STS and BO using a one-sentence definition for each of these three types of stress.
   
2. What primary processes are altered by stress?
   
3. What is one of the reactions to STS and CF that make it difficult for professionals to share with their peers the stress they are experiencing?
   
4. Although the following two terms are used interchangeably and their differences debated, what one distinction do some make between vicarious trauma and STS?
   
5. What is the primary ethical responsibility stated in professional code of ethics of those who care for a trauma population, trauma victims and/or respond to potentially trauma inducing incidents?
   
6. Fill in what you believe is the percentage of STS or CF experienced by staff in the following areas.
   Child welfare______, judges in criminal, family and juvenile court______, social workers______, hospice nurses______, emergency department nurses______, law enforcement officers______, forensic investigators______.
7. Approximately how much is spent in healthcare yearly as a result of BO?
   

Activities

1. List four stressors you experience as a result of the work you do. Following the fourth stressor add additional stressors you experience.
   
2. Circle any two of the stressors listed below that you have experienced.
   Intrusive (involuntary/unwanted) images, thoughts-sudden memories associated with cases … Distressing dreams about … Emotional/physical reactions triggered by reminders similar to those earlier case experiences, for example, when reviewing another case with similar details, walking into a similar environment, hearing case details similar to your experiences … Avoidance of thoughts, feelings, people, environments associated with trauma cases … Avoidance of conversations, activities or situations that carry reminders … Dreading seeing certain clients … Elevated arousal, such as being hyper-vigilant, jumpy, easily startled … Difficulty concentrating or focusing on details, gaps in memory, missing essential details … Trouble sleeping or staying asleep … Outbursts of anger or irritability … Becoming more impatient with clients … Feeling more detached, emotionally numb, flat … Thoughts of, “I’ve heard all this before,” “Let’s get this over with.” … After a few minutes you stop listening to some clients … Distrusting your ability to any longer be helpful … Find it difficult to shut off work mode when home … Withdrawing from activities, friends you once enjoyed.
3. What does CF/STS/BO sound like or look like?
   Write out a minimum of six statements for each of these three stress types (CF/STS/BO) that reflect how one might feel, think and/or behave if experiencing each of these stress types.
   BO: For example, My energy level sucks. It takes me forever to get things done now.
   
   CF: For example, I’m getting mad with clients who think their situation is the worst. It’s hard to feel for them the same way as I do about others who have it a lot harder.
   
   STS: For example, I am already thinking too much about my cases and some of the situations they’ve experienced even when I try not to.
   
   Keep your answers with you as you read through this first session. Compare your responses with those you will find in the session. This process will help you compare what you know and what you might yet still need to know to best respond to the stress of the work you do.

Session One

You Are Not Alone: It’s Not Your Fault

Imagine for a moment that you’re at a workshop that is titled “Developing Resilience in the Midst of Daily Exposure to Trauma.” The workshop flyer indicated that you would be learning about BO, STS, VT and CF: their prevalence, differences, how each impacts our performance, emotional, social and personal lives and all that can be done to remain resilient despite ongoing exposure to trauma populations and/or trauma inducing situations. After initial introductions, the presenter begins with a personal story.

Opening Statement: The Burning Pot

Allow me to give you a personal example of how stress can interfere with our thought processes, do damage and, in this example, end with a loss of $500 (rewritten from Steele, 2017):

Here I am a college educated professional, in my mid-thirties, single and living in a first-floor apartment with a door wall that led to an outdoor patio area. It was just several steps from the kitchen on the other side of a dining room table. One day the pot I was using to cook somehow caught fire. The flames rose over the edge and I had no fire extinguisher handy. I heard myself say, “ ‘remain calm.” My next thought was something like, “I got this.” I’ll just take the pot outside to the patio. I grabbed the pot and then walked over to the door wall but it was locked. Now visualize this. I sat that very hot, flaming pot on the linoleum covered floor to unlock the door wall. When I came back after putting the fire out, I saw what I had done. That’s right. I saw the outline of the pot on the linoleum floor. It had melted the linoleum, which can’t be patched. I thought I was thinking clearly under that minor stress. I could not believe what I had done. Besides losing my security deposit, I learned a valuable lesson.

Reality: Stress alters the way we think and process information and subsequently how we behave. When that stress piles up, what we think and how we behave only gets worse, the stress only gets worse. Everyone caring for others is vulnerable to several types of stress. (Answer to Pre-session One Question #2.)

This workshop is about

• increasing our awareness of different types and sources of stress, its various symptoms and the impact it has on our overall personal, emotional, cognitive and physical well-being and the quality of care we provide others,
• understanding that what we do leaves us vulnerable to personal and work-related stressors difficult to avoid,
• appreciating how prevalent these stressors are across helping professions; that they are not about our competence but our unavoidable reactions to continual exposure to the traumatic and demanding experiences of those we are attempting to help,
• developing neuro-based, trauma-sensitive, resilience focused, consistent self-care practices that minimize the impact of the kind of stress that is unavoidable when exposed to victims of trauma and those experiencing emotionally and challenging conditions* and/or to those responding to trauma specific situations, and
• remaining the best helper we can be despite what is the unavoidable, stressful challenges of caring for and protecting others.

Note: *Those experiencing emotionally challenging conditions could include a family member caring for an elderly parent, hospice nurses, EMTs, veterinarians and those working in animal welfare or teachers exposed to diverse student populations/traumatized students. One study conducted by the Humane Society of the United States (2003–2004) found in their sample of 1,000 animal control workers that over 56% self-reported extremely high risk for CF. Although research is just now beginning to examine CF/STS among teachers, we know that two out of three students struggle with stress dysregulation (SDR) creating a good deal of stress for educators (Transforming Education, 2015). There is another reality I want to present to you.

Reality: Stress is not a bad thing. It can lead to professional growth, improved skills and greater resilience if, rather than ignoring it or minimizing it, we acknowledge it and manage it by engaging in neuro-based, trauma-sensitive, resilience-focused, consistent personal and professional self-care practices.

Activity One: List, Look, Discover (Group/Individual)

Now imagine that the workshop room has 15 round tables and that there are 8 participants at each table; 120 participants are in attendance. Keep in mind that at your table there are a variety of different professionals working in various settings in different roles. At each table there is newsprint and markers, and a plain sheet of white paper for each participant. The presenter then prepares you for the following activity.

“Before we actually get to the content of this workshop, I’d like all of you to participate in two activities that will help lay the foundation for all we present today. Using the newsprint at your table you’re asked to discuss and then list four stressors that really make what you do difficult at times. You’re also instructed that after listing the fourth stressor you are to draw a line across the page underneath that sixth stressor and then continue to write down any other additional stressors that you face. You’ll have several minutes to do this. When finished each group is to tape their newsprint up on the wall.”

Processing the Activity

When all the lists are tapped on the wall, the presenter then says, “I want you to just look from where you’re sitting at these lists and think about the conclusions you can arrive at about stress, even though you may not be able to read what’s posted.” Quickly what participants see is that everyone has drawn a line across the page after listing their fourth stressor and then more stressors are added. The conclusions you have to draw about what you completed and what is the usual outcome when this is done in a group are:

1. Everyone’s dealing with stressors on the job.
2. Everyone’s experiencing many more than four stressors.
3. Stress is not something that can be avoided when working with at-risk and/or traumatized populations.
4. You certainly are not alone with your exposure to stress; what others are experiencing you are experiencing.

Once participants arrive at these conclusions, sometimes with a little help from the presenter, the following reality statement is presented.

Reality: You cannot expect to work with at-risk traumatized individuals or for an organization or program that services trauma victims or those experiencing emotionally challe...