Introduction Working in the helping field has its many joys and privileges. Seeing a child, whose self esteem is at the bottom, light up when he/she accomplishes a new task, see the growth an alcohol and drug addict has made in treatment, or to see the family, that when they entered the door of your office, was on the verge of separation, but now are communicating and working out their own needs with little assistance from you, their therapist, is some of the most rewarding moments one can experience.
However, to believe that life is all about these positive moments and that the battles you join in with others to overcome will not have an impact on you as a person, is wishful thinking at best. Undoubtedly, the day will come when we experience some form negative impact on our own mental health. That is, unless, proper self-care is practiced on an ongoing basis. Those in the helping field are at a great risk of what has been termed “compassion fatigue. ” On a continuum with burnout, compassion fatigue is a step over and both “burnout and compassion fatigue puts both the health care workers and their patients at risk” (Portnoy, 2011, p.47).
What follows is an outline of what compassion fatigue is, along with common signs, symptoms and risk factors. Following that is a self-assessment of personal risk factors and a self-care plan designed to assist in assuring that the risk of compassion fatigue is reduced in my professional career. Understanding Compassion Fatigue Compassion fatigue falls on a continuum of experiences associated with burnout and “secondary traumatization”(Figley, 1995). Unfortunately, many people make the assumption that they are the same thing. However burnout, secondary trauma, and compassion fatigue are not exactly the same things.
And those that seek to understand the risks associated with each will learn that there are differences. When an individual is finding dissatisfaction with their work environment and the stresses of the work he/she does, this is considered burnout. Secondary trauma is what occurs when we react to the situations of those that we are helping such as when I become distressed over the abuse of a child patient that I am working with. It is when we see the signs and symptoms of both burnout and secondary trauma that a person is experiencing compassion fatigue.
Compassion fatigue will affect a person in the cognitive, emotional, behavioral, spiritual, and somatic domains of life (Portnoy, 2011, p. 48). Portnoy (2011) reports the following signs and symptoms as related to compassion fatigue: Cognitive: Lowered concentration, apathy, rigidity, disorientation, minimization, preoccupation with trauma Emotional: Powerlessness, anxiety, guilt, anger, numbness, fear, helplessness, sadness, depression, depleted, shock, blunted or enhanced affect. Experiencing troubling dreams similar to a patient’s dream.
Suddenly and involuntarily recalling a frightening experience while working with a patient or family Behavioral: Irritable, withdrawn, moody, poor sleep, nightmares, appetite change, hyper-vigilance, isolating Spiritual: Questioning life’s meaning, pervasive hopelessness, loss of purpose, questioning of religious beliefs, loss of faith/skepticism Somatic: Sweating, rapid heartbeat, breathing difficulty, aches and pains, dizziness, impaired immune system, headaches, difficulty falling or staying asleep For those serving in the helping profession, it is important to be aware of the symptoms listed above.
Understanding the symptoms allows us to self-monitor our personal functioning as a member of the helping profession. Additionally, it will allow us to develop interventions that will address any symptoms that present in one’s life. Preventing Compassion Burnout For an individual to protect himself from compassion fatigue, it is crucial that he keeps his life in balance. This can be done by engaging in several self-care techniques such as taking time off from work, maintaining a healthy lifestyle that includes proper diet and exercise, and gaining proper rest (Panos, 2007).
Another preventative step for the social worker is to seek out individual therapy for himself as a manner in which to deal with the stressors associated with the helping profession. This has been highly recommended by several instructors during my masters level education. When I consider the risk factors discussed, I find that my weight and overall physical health are most significant in placing me at risk of compassion fatigue. Failing to have a nutritious diet has caused an increase in weight and multiple lower level health needs such as back pains and headaches.
When you factor this in with the stress of working a full time job and being a full time student, it compounds the problem as eating tends to be my coping mechanism of choice. I also have minimal intimate friendships due to lack of time to engage with others outside the workplace. A lack of these intimate relationships fails to provide me an outlet to the stress that is outside my family. Given the source of the stress is at work, confidentiality limits what I can and cannot say to my wife. With those risk factors, two protective factors that I see benefiting me is my spiritual support system and sense of strong professional boundaries.
My faith has pulled me through so much. Having a solid foundation in my faith has allowed me to always return to what it is that I believe and remember that it is my relationship with Jesus Christ that has called me into the helping profession to begin with. Scripture and prayer are vital parts of my life and provide the most significant amount of support in a field that is filled with what is at times overwhelming realities of just how evil this world can be. It also offers some friendships, albeit not as intimate as I would prefer, that support me through the process.
With professional boundaries, I learned very early in my career to establish boundaries up front with patients and their families. This has always protected me because when I sense those boundaries being pushed, I can go back with the individual/family and remind them of my role and the need to remain professional. This is a significant challenge in a small community of 3000 people because everyone knows me through my work and involvement in coaching my children’s sports. Beyond stated boundaries though, I believe that we have to develop the ability to rationally detach from the work we do to keep ourselves safe and effective.
Rational detachment is a phrase used in Crisis Prevention, Inc. training on how to effectively manage a crisis situation. It entails the ability to recognize that the circumstances of the patients are not personal to me. It is, for me, an ability to mentally detach from what is going on so that I do not personalize the situations and experiences of the patient, thus having a negative impact on me. It also includes mentally recognizing my own limits to knowledge and experience in the field, which allows me to justify that I cannot fix everything in front of me.
By recognizing my own limitations, I am then able to utilize my professional colleagues as resources to the challenges of helping others. Personal Symptoms At the personal level, my current signs and symptoms as related to compassion fatigue are minimal. Most symptoms fall in the cognitive realm with a lowered ability for concentration and signs of rigidity. Emotionally, the stress has led to times of anger that can be displaced towards friends and family members. These emotions are played out through behaviors of withdrawing myself from others and situations that I find enjoyable, being highly irritable and moody and poor sleep habits.
It has also at times caused me to question my religious beliefs and be more skeptical towards my faith. A tool that is commonly used for measuring the negative and positive effects of helping others who experience suffering and trauma is the ProQOL. This is a tool that has been developed and used since 1995 and assesses an individual’s risks for compassion satisfaction, burnout and compassion fatigue. This scale is free for use at the website http://www. proqol. org/ProQol_Test. html. My personal scores show that I am in the average range for compassion satisfaction and low ranges for burnout and compassion fatigue.
My Personal Self-Care Plan Taking care of yourself when working in the helping profession has to be a priority. Failure to do this can have serious implications, as discussed previously, on one’s personal life. To ensure that I reduce the risk of compassion fatigue, I must have a solid plan in place that supports my desires to help others while minimizing my risk. To do that, I recognize at this time in my life, the most significant areas that need to be addressed are my overall health, most specifically my diet and weight.
Additionally, developing stronger professional bonds at work and intimate relationships outside of work will reduce my risks. One last factor is to engage in individual counseling for the purpose of processing the stressors that come from working in the helping profession, mental health more specific. With that, I will work to implement the following plan for self care in my personal life. Goal 1: Improve my overall health. Actions steps: 1. Complete a men’s wellness exam with my primary care physician 2.
Develop a dietary plan of action with my primary care physician to reduce my weight to my ideal body weight over the next year. 3. Engage in rigorous physical exercise 3 times a week to improve overall physical and mental health. Goal 2: Increase my professional support Action steps: 1. Utilize clinical staff meetings to learn from professional colleagues and to staff cases from my caseload. 2. Continue to use individual supervision as support for personal needs that relate to the professional job. 3. Access an experienced clinician for personal support to process the stressors that are associated with mental health work.
Goal 3: Improve family and personal relationships Action Steps: 1. Establish date nights two times a month with my wife. 2. Identify one night a week as “family fun night,” which would be protected time that cannot be impacted by other events or activities. 3. Engage in weekly bible studies at church. Conclusion Proper self care is a vital part of any person’s life. However, when you engage in a professional field that takes on the role of assisting others in their self-care, it is all the more important to have a solid plan in place.
While most people can state that they understand the concept of self-care intellectually, putting a plan in place can be a challenge as many professionals focus on others at the expense of their own well-being. I as a professional must recognize that by taking care of myself, I am actually offering a better service to those I engage with by first and foremost, modeling what it means to take care of one’s self, but then also being mentally capable of coping with the stressors of the helping field. Self-care is not a selfish act, but actually the act of being selfless to those that we serve.
References Figley, C. R. (Ed. ) (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. An Overview. 1-20. New York: Brunner/Mazel. Panos, A (February, 2007). Promoting resiliency in trauma workers. Poster presented at the 9th World Congress on Stress, Trauma, and Coping, Baltimore, MD. Portnoy, D. (2011). Burnout and compassion fatigue: Watch for the signs. Jorunal of the catholic health association of the united states, 47-50. Retrieved from http://www. compassionfatigue. org/pages/healthprogress. pdf.