Burnout &
Compassion
Fatigue
Debra Hopkins
Staff Development & Training Coordinator
August 2013
OBJECTIVES
• Discover what leads to burnout and
compassion fatigue in your work
• Identify coping strategies that you can use
to increase your resiliency
• Develop ways to find support for yourself
and give support to your colleagues
• Help supervisors manage burnout and
compassion fatigue in the workplace
Personal Mission Statement
Take some time to complete
your personal mission
statement.
You will look at it again at the
end of the course.
The Data
• 57% of social workers have been threatened &
16% physically assaulted
• 40% of nurses have been physically assaulted
• 52% of behavioral health staff are at medium to
high risk for anxiety and depression disorders,
which is twice as high than the general
population
• Twice as many nurses used EAP than the
general employee population
• 59% of mental health professionals are willing to
seek help vs. 15% of law enforcement
professionals
Major Health Concern
Increased recognition of negative impact
on organizations – causes significant
work place disturbances
• High Attrition
• Poor Employee Retention
• Soaring Long Term Disability and Sick
Leave costs
Definitions
Burnout:
“Exhaustion of physical or
emotional strength or motivation usually as
a result of prolonged stress or frustration
that gradually builds to a breaking point.”
Compassion Fatigue: “A debilitating
weariness brought about by repetitive,
empathic response to pain and suffering,
compassion fatigue is a result of absorbing
and internalizing the emotions of clients and,
sometimes, co-workers….”
Burnout
Occurs when there is no joy left in doing
your job and you feel exhausted.
You often feel apathetic, a loss of emotional
investment, and an adoption of “what’s the
point?” attitude.
Burnout
 Physical & emotional exhaustion as a
result of prolonged stress and
frustration
 Depleted ability to cope with work
demands
 Sense of powerlessness to achieve
goals
 Alters our view of the workplace
 Can happen in any occupation
Compassion Fatigue
“A state of exhaustion and dysfunction,
biologically, psychologically and socially, as a
result of prolonged exposure to secondary
trauma or a single intensive event.” (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 that were primarily traumatized.
When was Compassion Fatigue Defined?
First diagnosed in Nurses in the 1950s. It
has also been discovered in other giving
professions, including social workers,
doctors, disaster response/relief workers,
attorneys, and charity workers, as well as
other “helping” professions.
Compassion fatigue has been studied by the
field of traumatology where it has been
called the “cost of caring” for people facing
other’s emotional pain.
The Compassion Fatigue Process
Figley, 2001
Who is More Likely to Develop
Compassion Fatigue….?
….Anyone with the capacity for true
compassion, empathy, concern & caring.
We try to stay within professional
boundaries and adhere to the training
guidelines we received.
However, our greatest strength, our
compassionate connection, is also our
greatest vulnerability.
This is not a characteristic to throw away.
Symptoms of Compassion Fatigue
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Despair
Hopelessness/Helplessn •
•
ess
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Decreased Pleasure
•
Stress & Anxiety
•
Negative Attitude
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Overwhelmed
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Powerlessness
•
Guilt
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Anger/Rage
Emotional
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Survivor’s Guilt
Shutdown
Numbness – No Joy
Fear
Sadness
Depression
Emotional Roller Coaster
Overly Sensitive
Vulnerable Feeling
Drained
Association with Trauma
Affects You Deeply
Symptoms of Compassion Fatigue
Behavioral
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Impaired Judgment
Impatient
Irritable
Withdrawn
Moody
Sleep Disturbance
Nightmares
Appetite Changes
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Hyper Vigilant
Startle Response
Accident Prone
Lose Items
Negative Reaction to
Small Changes
Symptoms of Compassion Fatigue
Cognitive
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Poor Concentration
Low Self-Esteem
Apathy
Rigidity
Disorientation
Perfectionism
Minimization
Preoccupation with
Trauma
• Thoughts of Self-harm or
Harm to Others
Symptoms of Compassion Fatigue
Personal
Relationships
• Decreased Interest in
Intimacy or Sex
• Mistrust
• Isolation
• Parental Over Protection
• Projection of Anger or
Blame
• Intolerance
• Loneliness
• Interpersonal Conflicts
Symptoms of Compassion Fatigue
Physical/Somatic
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Shock
Sweating
Rapid Heartbeat
Hypertension
Breathing Difficulties
Aches & Pains
Dizziness
Headaches
Increased Number &
Intensity of Medical
Maladies
• Impaired Immune
System
• Other Somatic
Complaints - the mind or
environment affecting the
body
• Substance Abuse
• Recurring Thoughts
About a particular Case
Symptoms of Compassion Fatigue
• Chronic Lateness
• Withdrawal Form
Low Morale
Colleagues
Low Motivation
• Personal Issues Intrude
Avoiding Tasks
on Work
Obsession Over Details
• Workaholism – cynical &
Apathy
discouraged yet can’t leave
work
Negativity
• Diminished Sense of
Lack of Appreciation
Personal
Detachment
Accomplishment
Poor Work Habits
Staff Conflicts
Absenteeism
Work Performance
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Symptoms of Compassion Fatigue
Spiritual
• Question the
Meaning of Life
• Loss of Purpose
• Lack of SelfSatisfaction
• Anger at God
• Question Religious
Beliefs
• Loss of Faith
• Skepticism
• Inability to
Maintain Balance
of Empathy &
Objectivity
Primary vs. Secondary Trauma
Primary Trauma:
• A consequence of one’s work, i.e. EMS, car
accidents, fatalities involving children
• From our personal lives, our own past
• Post Traumatic Stress Disorder
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)
Other Forms of Compassion Fatigue
1. Secondary Traumatic
Stress Disorder
2. Secondary Victimization
3. Vicarious Trauma
4. Emotional Hijacking
5. Cumulative Stress
SMALL GROUP EXERCISE # 1
 Discuss a case that caused you to “take it
home” with you or caused symptoms of
compassion fatigue.
 Identify the factors that caused you to
relate to the person/victim/family/event.
 Note the commonalities among you and
choose a person to share this with the
class.
Secondary Traumatic
Stress…
….when a client is experiencing a trauma
that you have personal experience with,
past emotions may be triggered, along
with feelings and personal trauma.
Some examples are homelessness,
physical
abuse,
emotional
abuse,
hospitalization, illness, death of a loved
one.
Secondary Victimization…
….when helping a client that is victim to
sexual, physical, or emotional abuse, you
may experience the trauma caused by
these events first-hand, though you didn’t
experience the event first-hand.
Vicarious Trauma…..
PTSD-related symptoms from working
with clients and families that have trauma
and grief:
 May co-exist with burnout
 May occur from exposure to one
case or a cumulative level of trauma
(Figley, 1995)
Vicarious Trauma….
….when a client’s traumatic experiences
affect you deeply even though you are
experiencing the trauma second hand.
• Vicarious: experienced through another by
imagining: experienced through somebody
else rather than at first hand, by using
sympathy or the power of the imagination
• endured for somebody else: done or endured
by somebody as a substitute for somebody
else
Vicarious Trauma….
 Repeated exposure to difficult stories
changes our view of the world
 Results in nightmares, certain images
repeated, intense preoccupation with a
story or event
 “When external trauma becomes an
internal reality it impacts the entire
nervous system” (Lipsky, 2009)
 Accumulates over time and across clients
 Occupational Hazard
Occupational Hazard
 We do not get Compassion Fatigue or
Vicarious Trauma because we made
mistakes
 We get it because we CARE
 It is a natural consequence of trauma
exposure
Emotional Hijacking…
….when your client’s emotions are strong
and you “catch a ride” experiencing their
emotions to a high degree.
Cumulative Stress…
….when your are unable to relieve
stresses that build, they add up and take
a toll, which can reach a critical point if
not addressed.
Burnout vs. Compassion Fatigue
DO I LOVE MY JOB?
Yes
No
Compassion
Fatigue
Burnout
Results are private and are to be used
for self-awareness and self-care.
QUIZ
 Life Stress Test
 Professional Quality of Life Scale Compassion Satisfaction And
Compassion Fatigue (PROQOL)
How do these areas
of our lives
influence each
other?
The Cost of Compassion
Fatigue…..
….At work:
Reduced Productivity
Negative influence on co-workers and
their productivity
Not able to serve clients to the best of
your ability
The Cost of Compassion
Fatigue…..
….At work:
“The cost of providing care is staggering.
The cost of not providing care, especially for
care providers is even more staggering. Job
stress is estimated to cost American
Industry 200 – 300 billion dollars annually as
assessed by absenteeism, diminished
productivity, employee turnover, accidents,
direct medical, legal and insurance fees,
worker’s compensation, etc.”
The Cost of Compassion
Fatigue…..
….To You:
Reduced effectiveness in all areas
Lowered self-esteem
Feeling guilty for not fulfilling
commitments
The Cost of Compassion
Fatigue…..
….To Those You Love:
You are emotionally drained
unavailable
Feeling disconnected or aloof
or
Take Steps to Reduce
Compassion Fatigue
1.
2.
3.
4.
5.
6.
7.
Social Supports
Self-Awareness
Meditation
Reduce Caseload
Limit Trauma Inputs
Work/Life Balance
Develop Resiliency
Social Support……
…in the workplace “is the most
significant factor associated with
compassion satisfaction (Killian study
of trauma counselors)
…colleagues
…friends
…family
…church
…pets
Self Awareness
Psychoneuroimmunology
Dr. Gabor Maté
• Long term effects of chronic
stress…..our immune system
does not exist in isolation
from daily experience.
• Chronically high cortisol
levels destroy tissue.
• Chronically elevated
adrenalin levels raise blood
pressure and damage the
heart.
Self Awareness
Being aware of feelings, actions & reactions, and gaining
an understanding of how I deal with anger, hurt,
resentment.
• Do I swallow my rage? Where in my body do I feel my
anger?
Being in tune with my stress signals.
• Do I have a good sense of how my body communicates
to me when I get overwhelmed? Do I get sick as soon
as I go on vacation, or develop hives or get a migraine
when I am stressed?
• Am I aware of the ways in which I sabotage my selfcare? By saying yes to requests I do not have time for,
by taking on more responsibilities, by cancelling a
therapy appointment?
Self Awareness
Being aware of the dynamics from our past that
influence the every day choices we make:
• Why did I choose to go into this field and not
another?
• Did I pick this profession because of a trauma or
loss I experienced in my own life?
• Was I already a helper in my family of origin?
• Am I the “go to” person in my personal life?
• Do I feel empty or unimportant unless I am in a
helping role?
Understanding how my own childhood history affects
my reactions to my clients’ stories (counter
transference).
Meditation
Mindfulness Based Stress Reduction
 Jon Kabat Zinn defines as, "a moment-tomoment, non-judgmental awareness."[
 25 years of studies demonstrate that MBSR
helps reduce emotional distress and manage
severe physical pain.
 MBSR has been used successfully with patients
suffering from chronic pain, depression, sleep
disorders, cancer-related pain and high blood
pressure. (Cohen-Katz t. al.)
www.compassionfatigue.ca
Reduce Caseload
Rebalancing & Reducing
Caseload/Workload
To combat compassion fatigue and
burnout, agency administrators may want
to ask themselves, “How many cases are
too many for staff to be effective for
clients?”
Two kinds of debriefing
(1) the informal debrief, which often takes place in a
rather ad hoc manner, whether it be in a
colleague’s office at the end of a long day or in the
staff lunchroom, where the recipient of the
traumatic details, rarely has a choice in receiving
this information.; and
(2) the formal debrief which is a more structured
process, and is normally scheduled ahead of time
and often referred to as peer consultation,
supervision or critical incident stress debriefing,
which lacks immediacy in the case of vicarious or
secondary trauma.
Low Impact Debriefing
Preventing Re-Traumatization
1) Increased Self Awareness
Were all those details necessary to the storytelling?
2) Fair Warning
If I know that you are coming to tell me a traumatic story, I will
be prepared to hear this information and it will be less
traumatic for me to hear.
3) Consent
The listener has a chance to decline, or to qualify what they
are able/ready to hear.
4) Limited Disclosure
Decide how much to share. How much detail is enough?
How much is too much?
Improve Work/Life Balance
Duxbury Report on role overload in health
care:
1) 35% of health care workers suffer from role
overload
2) 36% report high levels of depressed mood
3) 1 in 4 employees were planning to leave
their job at the hospital, not for higher pay, but
for greater control over work hours and for
more respect.
Improve Work/Life Balance
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Relationships
Environment (clutter, etc.)
Work
Money
Mind, Body, Spirit
Develop Resiliency
Help for the Helper: The Psychophysiology
of Compassion Fatigue and Vicarious
Trauma (Norton Professional Books)
…the ability to keep on going
when the going gets tough….
Research shows that those who
can “turn off thoughts about
work” are more resilient during
their careers
Self-Care
 Are you aware of your specific
vulnerabilities?
 How do you protect yourself
while doing this very challenging
work?
 Were you trained for this?
Mother Theresa…..
…..wrote in her plan to her
superiors that it was
mandatory for her nuns to
take an entire year off from
their duties every 4 to 5
years to allow them to heal
from the effects of their
care-giving work.
Results are private and are to be used
for self-awareness and self-care.
QUIZ
 Compassion
Satisfaction/Fatigue Self-Test
for Helpers
SMALL GROUP EXERCISE # 2
 Discuss the causal factors of Compassion
Fatigue.
o Each helper’s empathic engagement with each
client’s unique experience
o Helper’s unique personal response based on
personal
history,
style,
current
life
circumstances, as well as proximity and
personal connection to the events and people
involved in the trauma/tragedy
 Discuss
potential
consequences
for
undiagnosed and untreated compassion
fatigue.
The ABC’s of Prevention
Awareness
Balance
Connections
More on
Awareness
1. What types of cases contribute to your
stress level?
2. What events or situations cause you to
experience unusually strong reactions?
3. Which cases overpower your usual
coping mechanisms?
4. Are ordinary incidents becoming
“traumatic”?
5. Is your ability to function altered?
6. Are you losing your normal boundaries?
More on
Awareness
7. Do you regularly wake up tired and struggle
to get to work?
8. Do you feel as if you are working harder yet
accomplishing less?
9. Are you becoming frustrated/irritated easily?
10.Are you losing compassion for some while
becoming over involved with others?
11.Do you routinely feel bored or disgusted?
12.Are you experiencing illness, aches &
pains?
Balance
1. Practice excellent self-care.
2. Nurture yourself by including activities
in your schedule that are sources of
joy, pleasure, and diversion.
3. Allow yourself to take mini-escapes to
relieve the intensity of your work.
4. Transform the negative impact of your
work; find meaning, challenge
negativity, find gratitude.
Dr. Francis J. Braceland…..
…..”We can be sure
that the greatest
hope for maintaining
equilibrium in the
face of any situation
rests within
ourselves….”
Balance
Find Hidden Passion
• We all have hidden sources of energy
and healing power.
• When you identify the things that fuel
you, the things that you have true
passion for, your fatigue will disappear.
• Balancing life involves including the
things that you value and have passion
for in your schedule.
Balance
“When you are inspired by
some great purpose, some
extraordinary project, all your
thoughts break their bonds:
your mind transcends
limitations, your consciousness
expands in every direction, and
you find yourself in a new,
great, and wonderful world.
Dormant forces, and talents
become alive, and you discover
yourself to be a greater person
by far than you ever dreamed
yourself to be”
The Yoga Sūtras of Patañjali
are 196 Indian thoughts written
in a memorable form.
Balance
• Meditation is an excellent way to ground yourself in the
moment and keep your thoughts from pulling you in
different directions.
• The ability to connect with a spiritual source will help you
achieve inner balance and produce a significant turn-around, even when your world seems dark.
• Have a quiet time alone in a calm, beautiful place, a safe
retreat where you feel renewed.
• Find ways to acknowledge loss & grief.
• Remain clear and true to career goals and personal
mission.
• Focus on what you can control.
• View situations as challenges & opportunities rather as
problems or stresses.
Balance
Re-charge Your Batteries Daily:
• Commit to a nutritious diet and stop all other
activities while eating. This will have an exponential
benefit on both your psyche and physical self.
• Regular exercise will reduce stress, help you
achieve balance and re-energize you for time with
family & friends.
• Spend time daily on an activity you find meaningful
that is not related to work. This may be something
you do alone or with others; reading, walking,
listening to music, playing with pets, a hobby,
whatever energizes you.
SMALL GROUP EXERCISE # 3
 List one mini-escape or
diversion that worked well
to restore and renew you.
 List one thing that brings
you joy.
Connections
• Hold one focused, connected and meaningful
conversation each day. Sadly, this is the first thing to go
when time is scarce. Time with family and close friends
create feelings of connectedness and belonging that are
lost when experiencing compassion fatigue.
• Talk about your stress; process your thoughts with
someone – co-worker, therapist, clergy, friend, family,
supervisor.
• Build a positive support system that supports you (not
fuels your stress)
• Blood pressure and heart rate decrease when interacting
with animals.
Pets are invulnerable to “provider
burnout”.
Words of Advice
•
•
•
•
•
•
•
•
•
•
Do not quit your job
Do not make a significant relationship decision
Do not make a lavish spending decision
Do not blame colleagues
Do not blame administration
Do not blame “The system”
Do not initiate legal action
Do not spend your energy complaining habitually
Avoid commiserating with discontented colleagues
Do nut try quick fixes such as alcohol or drugs
Managing Workplace
Toxicity
• Avoid feeling wronged and bitter, a
sense of helplessness, of being
persecuted
• We become convinced, by ourselves
and others if we allow it, that others are
responsible for our well-being and that
we lack the personal resources to
transform our thoughts, actions and
circumstances.
CONCLUSION
Unrecognized and Untreated
Compassion Fatigue causes people to:
• Leave their professions
• Self-Treat with Drugs or Alcohol
• Become Suicidal or Self-Destructive
Watch Out for Each Other.
If You See a Colleague in Distress,
Reach Out to Them.
Maya Angelou…..
…..”The quality of
strength lined with
tenderness is an
unbeatable
combination….”
On-line Resources
Compassion Fatigue Awareness Project
www.compassionfatigue.org
Compassion Fatigue
http://www.breathofrelief.com
Personal Mission Statement
Look at your Personal Mission
Statement again. Do you see
things any differently after
examining yourself more
closely today?
Take Good
Care of
Yourself!