Taking Care of Yourself

 When the helper finally gets around to seeking support for themselves, sadly there is likely to already be a significant amount of impairment to that person. The personality of the helper along with their survival defense mechanisms enable them to deal with the stressors of their profession at the cost of their own health. There are many terms that are surfacing that reflect the impact of stress on the helping profession, burnout, secondary traumatic stress, compassion fatigue, vicarious trauma, and contact victimization, are being further researched. Differentiating between the various terms have assessment and treatment implications.  Clarification and  appropriate use of terminology is necessary.

Burnout

Most of the literature regarding the consequences of being in a stressful profession have to do with what has been termed as “burnout”.  Burnout has been that term associated with being in and dealing with high levels of stress over a period of time without recuperative breaks. Burnout is further defined as a collection of symptoms associated with emotional exhaustion. Burnout is a process that occurs over time not as a result of a fixed event although there may be powerful fixed events that occur along the process. It begins gradually and progressively gets worse. Occupationally, it can begin with job strain, the erosion of idealism, void of achievement, and the accumulation of  intense contact with clients.  Symptoms can include:

Secondary Traumatic Stress

Secondary Traumatic Stress (STS) does not progress over a period of time, but occurs suddenly and unexpectedly.  With that, the onset of symptoms occur more rapidly.  Pervasive symptoms include a dramatic sense of helplessness, a sense of isolation from supporters, and symptoms disconnected from real causes (Figley, 1995). STS is defined as the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experience by a significant other.  It is the stress resulting form helping or wanting to help a traumatized or suffering person,  (Everly, 1999).  Secondary Traumatic Stress Disorder (STSD), closely resembles the criteria for Post Traumatic Stress Disorder (PTSD) with the primary difference being that the source of trauma comes from the relationship with the primary victim. 

Compassion Fatigue

Compassion fatigue  is becoming a more popular term that is interchangeable with STS. It is a term that has come to be known as resulting from the cost of caring (Figley, 1982) for others in emotional pain.  This user friendly term, does not carry the clinical implications that STS, STSD, or vicarious traumatization, so resistance or denial about being affected may be easier to hear, but the terms are interchangeable.  However, I would state that "compassion fatigue" carries the connotation that its onset is less sudden.  That there is a "tiring process" inherent by the use of term "fatigue" that resembles the process of burnout more so than the onset of traumatic stress.  Nonetheless, compassion fatigue can arguably occur over a period of time and/or a sudden response to working with a traumatized client. When comparing to burnout, there are differences.  Burnout is a more general term encompassing a wide variety of variables that may effect ones ability to tolerate stress.  The term burnout also reflects individuals involved in the workplace.  The symptoms of burnout and compassion fatigue are also different as seen in the table below.

Compassion fatigue on the other hand, can be seen more as a subset of burnout, a special form of stress reaction particularly experienced by individuals in the helping profession.

Can an individual in the helping profession experience burnout or is it compassion fatigue?

Yes. An example which differentiates the two experiences are where a therapist may work for an organization and have a caseload of clients. Also within that working system is a supervisor that he/she does not get along with and believes the supervisor to be unfair, unsupportive and punitive.  There is little room for advancement, little participation in the decisions that effect the success of the organization and the caseloads are unmanageable with the average workday.  The employee dislikes coming to work, avoids the supervisor, irritable with colleagues, and is less detailed in the work he/she is expected to do, leading to further conflict with the supervisor. This worker is experiencing the symptoms of burnout.  While there may be stress related to the type of cases they are working on, the stress reactions are not the result being a helper, but that of working in an organization where the workers needs are unmet and expectations unfulfilled.

Suppose now, one of the cases the worker was involved with had a child commit suicide.  The worker intervened with the family's soon after the death was found, and with all else being the same, the worker after several days could not sleep, had nightmares, had vivid images of the description of the suicide scene as described by the family that they could not shake, the worker would be struggling with Compassion fatigue.

Basis of Compassion Fatigue

1.  Empathy is a major resource for the helping profession to help the traumatized.  Let's face it, empathy and the ability to empathize are a key to  therapeutic, helping profession relationship.  To be able to view a problem from the perspective of the client, empathetic behaviors promote trust and engagement. It allows a connection to develop and an alliance that in itself can be healing.  This same mechanism of healing can and will expose the helper to traumatic material often at times with the intense emotional reaction as if it were being re-experienced. This powerful interaction can lead to the healer being traumatized as well.

2.  Many of the helping profession, especially trauma workers, have experienced trauma as well.- It is often observed that those who have been deeply affected in some emotional way by some powerful force either positively or negatively are attracted to similar types of exposure throughout their life. Studies have supported that personalities of first responders often identify some form emotionally significant events in their life.  Often professional careers are chosen, volunteer work selected, and dysfunctional relationships created that either consciously or unconsciously, contribute to the choices that are made throughout life.  There is seemingly a pull or lure to the intensity of seemingly like events. 

3. Unresolved trauma of the worker will be activated by reports of similar trauma in clients. Along with number 2, some of the experiences of workers who have been traumatized in life may have issues that are unresolved and activated in the present trauma.

4.  Children's trauma are also provocative for caregivers.  Trauma to children have been reported as the number one contributor to compassion fatigue by emergency responders( Beaton and Murphy 1995).  The trauma worker is most likely to be exposed to children's traumatic experience either directly or through family interventions.

Conclusion

Working in this field is very rewarding. Intervening prior to the full impact of trauma and its power to reshape one's view of themselves and the world, most times permanently, is a responsibility not to be taken lightly.  One must ask themselves, "Am I capable of acting in such a capacity knowing that every bit of my involvement contributes in some way to the reconstruction of one's psyche, their spiritual outlook and a sense of wellness?"  Often we arrive on the scene or at the workplace and step into a very disrupted arena.  Whether it is our job to be there, or we were summoned in some way, we often enter into another's tragedy uninvited by them.  They are not able to check our credentials, our experience, or whether or not we have our own s*** together, they readily accept the hand we extend.  They will grab it, because they are vulnerable.  Their instinct to survive dictates their movement.  There willingness to listen demonstrates a level of trust in what you have to offer. It requires more than just a desire to help but a reciprocation of that trust in knowing and conveying you are the right person at this moment of need.

The person that extends their hand to me in a time of extreme need, better be trained, empathetic, resourceful, professional, available, and have their own house in order. Isn't that what you would want?  Is that who you are?

I hope this training has advanced your learning and increased your awareness of the many issues at hand. Please feel free to contact me for questions, comments, and additional training services.

Bibliography

This concludes the training. Thank you. I hope this has been helpful.

Robert D. Intveld, LCSW

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