OVC Provider Forum Transcript

Compassion Fatigue
Viki Sharp  -  2005/7/6
Are there a high number of professionals that leave the business or move from the direct care positions due to no support from their own management team? Thus createing a type of victimization among providers.
1.  Kimberly Edward
 I feel there is not a high number of professions that leave due to no support. I think if you are with a good team of people that it will make it a little more easier.
2.  Mary Pat
 It is my experience that professionals do leave direct care positions secondary to the lack of support from within their respective organizations thus creating an organizational victimization.
3.  V Sharp
 I truly dont know what the statistics show on this topic. I observe in todays work place that many young people start out in victim assistance for a year or two and then move on. At the beginning of the movement we had staff and volunteers that stayed forever. The culture was that it was a calling or mission, not a job. We worked around the clock and felt there was more to do than we could accomplish in our life time. I dont even remember having management team issues in the early years. It was about great big issues like the criminal justice system, legislation, shelters and resources, establishing rights etc. We just did what needed to be done and didnt consider work hours, pay, management or rules! As victim advocate jobs became more mainstream and incorporated into formal agencies, work structure and management became an issue. In recent years, my personal experience was that management was much more receptive to plans for preventing vicarious trauma and compassion fatigue than the advocates themselves.
Miss Viki, can you please address the stress that comes from individuals and orgs not getting along, being petty, and fighting over limited funding and, believe it or not, victims??? Thanks, sister!
1.  V Sharp
 Well, Ms. Anne, there are many factors that contribute to the mind boggling, crazy in-fighting in our field. Answering strictly from the compassion fatigue paradigm, when you dont take care of yourself and just give, give, give to others, you become a CF and VT magnet. Folks who are experiencing CF and VT are not exactly warm and fuzzy, considerate and supportive of others, or terribly logical. The mission of assisting victims and making the CJS more victim responsive, takes a back seat to the struggle to stay afloat and collect all the marbles first. The traumatized fatiguers lose sight of the fact that it was the grassroots, team work that enabled us to survive and get this far and we are sunk without each other. Together, we can accomplish anything. Divided, we create more stressors for everyone. Those are who doing the in-fighting and negative stuff may very well be in need of time off, acknowledgement and support. I say, embrace em!
How do we identify that we are beyond the daily stresses that come as part of serving victims, and are in danger of compassion fatigue, personally.
1.  Cindy Schiller
 As we strive to imagine the victims feelings and reactions, our hearts and minds absorb the pain.I am a registered nurse and this seems very prevalent in my line of work as well as many other service professions. I definitely would have to say that in my daily work I do absorb my patients' pain with my heart and mind and it is often very difficult to deal with this.
2.  V Sharp
 There are many different signs that the work is affecting you beyond normal stress. Perhaps the three most prevalent are the change in world view, loss of spirituality and loss of sense of humorjoy. When you cease to feed your spirit, feel like your work has no meaning or purpose and are unable to find joy and laughter, you are definitely in trouble. Interestingly, those who are the most empathic advocates are usually the most severely affected. As we strive to imagine the victims feelings and reactions, our hearts and minds absorb the pain. Sometimes we may need to do things contrary to our training, such as putting an artificial barrier like a desk between us and the client to create a little bit of distance and separation.
It seems as if compassion fatigue and vicarious trauma are subjects of greater concern because of the myth that "anyone who does this work should be able to 'take it,' and be able to 'hold up' under the strain." Do you have any thoughts on how we can help service and support providers tell their "stories" more easily and more widely without feeling that they are either "weakening" of that they might be breaking confidentialities? It just seems to me that we need to more widely honor the needs of providers to "talk out" some of what they are holding inside without fear of judgment. Is there a way?
1.  Melody Horrell
 I just want to applaud your answer to Jon's question. I do hope there can be a culture shift in this direction--focusing on the care of the caregiver. Maybe it is the lack of self-care that ultimately causes burn-out in this field. It is so important that those in this field who have a passion to help victims be kept well enough themselves so that they can continue to serve. What do you think about the idea of a 'victim services' group that could meet for an annual retreat? I think that the field we are in is so vital to every community and our nation as a whole that we have to make a commitment to take care of ourselves so that we are able to provide the level of service that the people we are serving deserve.
2.  AdvocateII
 I have worked in this field for 17 years now...my body is full of arthritisand pain I have sleepless nights, I have many physical problems....my concentration is suffering and my personal life has suffered much. I love my work, and value what I do, but I need help. I need to find help, how?
3.  Andrea Cleeton
 I work with child welfare workers who seem to have bought in to this idea that they are somehow weak if they take time off or try to limit their workloads. They are all so overworked, they feel guilty taking any vacation time as they know this will put more work on their co-workers. I agree it is a systemic problem, and that supervisors and administration need to make worker safety and health a top priority.
4.  Mary Pat
 I could not agree more with Viki's response to this question. We need to step forward and change the culture within, embrace ourselves and each other for the change.
5.  V Sharp
 Great question. I really think it begins with a culture shift. For many years we have applauded and awarded those who selflessly gave their life and health to work around the clock to help others. We act surprised at the number of heart attacks, health issues and addictions in the field. I remember being at a conference where we did a standing ovation for a post-humus award given to a colleague who had collapsed and died after working non-stop at a disaster scene. I think we also need to value, acknowledge and reward folks when they contribute, yet prioritize their own lives and families, stay healthy and in balance. I have not yet seen an award for that purpose. Humans tend to repeat what is acknowledged and valued. Our helper culture rarely values self care. Whenever I have done journaling exercises with advocates the raw pain that emerges is almost scary. It is no wonder so many numb the pain with alcohol, anti-depressants and other addictive behaviors. Yes, there is a way. We shift the culture. We declare that processing, saying no, setting boundaries and taking time for ourselves and our families is the way we ultimately are able to do the best job of helping others. We acknowledge, value and reward that behavior.
Dear Ms. Sharp, I've worked in a county correctional facility for over 14 years. Having taken a victim advocacy course, and knowing that many who are incarcerated here have also been victims many times over in a varity of ways since their youth, I'm wondering if you can address the emotional burnout sometimes found among corrections officers and street officers. How can we remain effective, compassionate, empathetic and patient amidst the ugliness we see and hear on a daily basis?
1.  V Sharp
 Youre correct, it is very difficult when you are exposed on a daily basis to the ugly side of life. Laurie Anne Pearlman puts forth the Constructivist Self Development Theory that says our cognitive assumptions, the way we view the world changes when we are continuously exposed to things like criminal behavior. Most officers wont sit with their back to the door in a restaurant. We see the potential for evil in people and situations. We describe areas in the community we live in by crime scenes rather than beautiful spots! Our world view changes. We have to balance it with the positives and beauty in life. Find people who dont do this work, spend time with them. Quit watching the cop shows on tv. Schedule family time, fun activities, interesting lectures and new hobbies that dont relate to law enforcement issues. Get a mentor. Find someone who balances life and ask for coaching. While off duty fill yourself up with the good things life has to offer, so there is not as much room for the sadder things to take root.
Viki, Crime Victim Compensation and Victim Service grant Programs staff do not work directly with victims on a daily basis but are exposed to victim trauma through police reports, medical reports, and direct service provider contact. While they don't work directly with the trauma a victim is experiencing, they also rarely are witness to the victim's recovery and healing. What, in your experience is the effect of this more tertiary exposure to the trauma of crime and are there ways we can help workers?
1.  Melody Horrell
 I have been working with victim compensation for over 12 years. While victim compensation program staff may not deal directly with victims, they do often talk to them extensively by phone, and hear a lot of details about what happened and the impact it has had on their lives. Our work is also confidential so we are not allowed to talk about claims outside of the agency. Does it help someone to lessen the affects of CF or VT if they are able to talk to co-workers in the workplace?
2.  V Sharp
 You are absolutely correct that direct victim contact and crisis work is not necessary for significant trauma impact. A number of research projects found that jurors who heard and saw evidence were susceptible to PTSD and long term crisis reactions. Everyone in the victim assistance network including advocates, volunteers, law enforcement, attorneys, receptionists, dispatchers, support staff, etc. are impacted and should be included in vicarious trauma training and organizational response plans. You also raise a good point about seeing the positive impact our efforts achieve. A painter at the end of the day sees an accomplishment. I think most of us at times have asked the question, Did I really make a difference? This feeds into feelings of hopelessness and overwhelm. It is vital for us to support each other, share our successes and acknowledge our trauma
What can you recommend for a case manager/advocate who carries the client load (approximately 25-50 new clients/month) for a non-profit, faith-based organization that does not have the financial resources to hire additional help. It's difficult to schedule mental health breaks, vacation, or find ways to lighten the emotional and physical stress.
1.  Eileen Turner
 Thank you for your response. We do train and utilize volunteers for direct field response to victims through our victim chaplain and crisis responder training. We need more volunteer help in the on-going case management area of the organization. While the clients are sometimes served at the point of victimization by a trained volunteer...this does not lessen the load on the staff case manager. We are dedicated to training more volunteers for all areas of response.We recruit trained (LPC or LPCI), volunteer crisisvictim counselors who respond directly to clients. Administrationon-going case management is the area that we've found it difficult to recruit volunteers for. Would love to have an intern!
2.  V Sharp
 Have you thought about training and utilizing volunteers? Volunteers bring a whole different dynamic to an organization. They frequently are not as impacted by vicarious trauma since they dont do this work full time and have other interests and activities. They can also be good role models and coaches as far as achieving balance. I understand that it is difficult to schedule vacation time when there is so much need and few resources. Make it company policy that vacation time must be taken. Experiment with flex schedules, hours, volunteers, technology and other ways to stretch the resources. A burned out advocate does no good for anyone in the long run and certainly does not model self care for clients.
Sometimes I feel drained and somewhat overwhelmed after speaking with some victims. I already meditate, exercise, and get help with my own issues. What other suggestions do you have? Thank you.
1.  Barbara Grissom
 I have found that having a circle of friends that have nothing to do with victim services has been very helpful to me.
2.  Lynette Murphy
 I find that speaking to colleagues that do the same kind of work can be helpful as well.
3.  V Sharp
 Meditation, exercise and personal counseling are great - hurrah for you! Some other ideas: journaling- great research on the effects of writing down your feelings and processing.Massage - we store our stress in our bodies - the body remembers when the mind does not.Balancing the senses - we take in the painful stuff through our senses so nurturing each sense is a great tool i.e. music, aromatherapy, bubble baths!Fun and laughter - an absolute MUST! Get a funny movie, recruit fun friends etc.Laughing is an aerobic exercise!
In addition to employee assistance programs that are voluntary. What would be examples of in house approaches for supervisors to address this type of fatigue in both immeditate and long term circumstances?
1.  Michaela Anders
 Where would one find the stress check-up inventory created by Saakvitne & Pearlman?
2.  V Sharp
 Although employee assistance programs are voluntary, it is still important to let folks know you support their utilization and that it is a positive thing - not a stigma. When you do semi-annual or annual performance reviews, include questions about CF and VT. Create a buddy system where employees have a partner and sit down once a month and do a stress check-up inventory together. Saakvitne and Pearlman created a great one in 1996. Develop a plan for your organization and put it into effect.
What are 2 of the best ways that I can help my staff reduce or eliminate compassion fatigue without having them reduce their hours to under 40?
1.  V Sharp
 Have an annual retreat where you get away and do lots of classes that give them tools for balancing the stress. We got a YMCA camp for two days and did everything from yoga to swimming, massage, bird watching, journaling to hiking and volleyball.Consider rotating job responsibilities to change the menu a bit. Working as teams when possible is also helpful - reduces the lone ranger effect.
Greetings! I work in a domestic violence and sexual assault (including child sexual assault agency). I am one of four advocates and we would like to know the symtems of CF and the difference between that and burnout.
1.  V Sharp
 Wow! You have tough jobs...Burn out is when you have simply had it and cannot do this work any more. Its time to pack your bags and move on. Compassion fatigue is when you just get tired of always caring about everyone and everything. You are drained. Vicarious trauma is an accumulation of repeated exposure to grief, pain, trauma, sadness. CF and VT can be helped! McDermott, Fellbaum and Associates have a stress symptom checklist that is very good and they suggest having a colleague or loved one complete one on you since they usually notice the symptoms before you do! Symptoms may include: no time or energy for self, social withdrawal from others, generalized feelings of hopelessness & despair, sleep issues, changes in world view, diminished ability to handle strong feelings and altered sensory experiences.
Can you provide any insight to a relatively new member to the victim services family on how to avoid "compassion fatigue" before it starts?
1.  V Sharp
 I think we are less susceptible to CF when we are centered and balanced in our personal lives. Counter-transference is most likely to occur when we have our own personal stressors occuring, when there are similarities between us and our clients and when we are tired or overwhelmed. Learn when to delegate, when to ask for help, when to say no and what works for you, personally, after a tough day. Ask significant people in your life to be a barometer for you and teach them how to help you get back on center.
How do you help your employees identify their compassion fatigue without steeping on their toes?
1.  V Sharp
 Difficult issue - we tough guys don't like our weaknesses pointed out. I think having a plan in place for the organization is critical and makes it seem inclusive rather than singling an indiviual out.Each plan may be tailored to the specific group and at a minimum should include:1) Initial training for ALL employees and volunteers that defines vicarious trauma, the causes and tools for prevention.2) Annual training for review and new information3) Regular self assessment tools such as checklists, inventories, buddy systems to foster awareness of attitudes, stress levels and VT symptoms 4) Employee assistance, counseling resources and work time to attend5) A culture shift that supports self care and does not reward self sacrifice6) Team work (partnering) whenever possible instead of lone rangers7) Job rotation, flexible schedules and time out from direct serviceUltimately the individual has responsibility for caring for themselves, but I do think the organization must provide training, opportunities, responses and resources or face potential liability andor loss of skilled employees.
I am a member of a critical response team for a law enforcement department. We deal with our own staff members who have experienced trauma ranging from personal issues to critical incidents on the job. Do you have any advice for the peer "counselor" who provides support to peers experiencing trauma, particularly around issues of dealing with what they have heard and maintaining confidentiality? Do you have any specific advice on ways to avoid burnout or sympathetic traumatization?
1.  V Sharp
 Peer counseling has some advantages and disadvantages. You already have some trust and a relationship which gives you entree. However, confidentiality gets difficult, while still being an essential element of the helping relationship. I find myself continually wrestling with this issue at ADC and welcome others' ideas. One specific for law enforcement is to be sure to recruit lots of friends in other professions, We tend to hang out together and re-infect each other!
Can you suggest specific prevention strategies that direct care and work supervisors can implement?
1.  V Sharp
 First, develop and implement a plan. Have regular training on this topic. Continued job training also reduces stress - more tools and confidence, less pressure. Encourage an annual check up with their physician AND counselor. Rotate job assignments. Provide a variety of tools for measuring stress, CF,VT levels. There are a bunch out there. There are also some great work books. Be sure employees take vacations each year. Provide opportunities for wellness activities, including posting community classes in areas like meditation, drumming, yoga etc.
2.  Lynette Murphy
 How about conducting regular clinical supervision sessions in a supportive environment. This way staff members have a consistently scheduled forum for addressing concerns or gaining knowledge from guest speakers with expertise in the field.
What are some suggested readings, training resources, etc. that you can offer to someone developing a training presentation on self-care and understanding compassion fatigue for victim advocates. I'm specifically interested in resources that would include activities that would get learners involved in the training program.
1.  mblaise
 Compassion Fatigue & Vicarious Traumatization References:Charney, A.E., & Pearlman, L.A. (1998). The ecstasy and the agony: The impact of disaster and trauma work on the self of the clinician. In P. Kleespies (Ed.), Emergency psychological services: The evaluation and management of life-threatening behavior, pp. 418-435. New York: The Guilford Press.Figley, C.R. (Ed.). (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: BrunnerMazel.Follette, V.M., Polusny, M.M., & Milbeck, K. (1994). Mental health and law enforcement professionals: Trauma history, psychological symptoms, and the impact of providing services to child sexual abuse survivors. Professional Psychology, 25(3), 275-282.Maltz, W. (1992). Caution: Treating sexual abuse can be hazardous to your love life. Treating Abuse Today, 2(2), 20-24.McCann, I.L., & Pearlman, L.A. (1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation. New York: BrunnerMazel.McCann, I.L., & Pearlman, L.A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3 131 - 149.Neumann, D.A., & Gamble, S.J. (1995). Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist. Psychotherapy, 32(2), 341-347. Pearlman, L.A. (1995). Self-care for trauma therapists: Ameliorating vicarious traumatization. In B.H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators, pp. 51-64. Lutherville, MD: Sidran Press.Pearlman, L.A., & Mac Ian, P.S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26(6), 558-565.Pearlman, L.A., & Mac Ian, P.S. (Summer 1993). Vicarious traumatization among trauma therapists: Empirical findings on self-care. Traumatic StressPoints: News for the International Society for Traumatic Stress Studies, 7 (3), 5.Pearlman, L.A., & Saakvitne, K.W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton.Pearlman, L.A., & Saakvitne, K.W. (1995). Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In C. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, pp. 150-177. New York: BrunnerMazel.Pearlman, L.A., Saakvitne, K.W., et al. (1995). Vicarious traumatization I: The cost of empathy. Ukiah, CA: Cavalcade Productions, Inc.Pearlman, L.A., Saakvitne, K.W., et al. (1995). Vicarious traumatization II: Transforming the pain. Ukiah, CA: Cavalcade Productions, Inc.Rosenbloom, D.J., Pratt, A.C., & Pearlman, L.A. (1995). Helpers' responses to trauma work: Understanding and intervening in an organization. In B.H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators, pp. 65-79. Lutherville, MD: Sidran Press.Saakvitne, K. W. (1995). Therapist responses to dissociative clients: Countertransference and vicarious traumatization. In L. M. Cohen, M. R. Elin, & J. N. Berzoff (Eds.), Multiple personality disorder: Critical issues and controversies. New York: Jason Aronson.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.Schauben, L.J., & Frazier, P.A. (1995). Vicarious trauma: The effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly, 19(1), 49-64.Stamm, B.H. (Ed.).(1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators, 2nd Edition. Lutherville, MD: Sidran Press.
2.  V Sharp
 Some video's: When Helping Hurts: Sustaining Trauma Workers from Gift From Within is super.Vicarious Traumatization I and II - Cavalcade Productions,also a workbook that is very good.Some Days...the Dragon Wins Helping Wounded Helpers Heal by Bill McDermott and Tony Fellbaum was very helpful to me.There's a good book by Dr. Charles R. Figley on Compassion Fatigue.Googling Compassion Fatigue on the internet will give you some other resources. There's a lot more out there than there used to be.
3.  Vermilyea, Eliz
 The Sidran Institute has several books on Compassion Fatigue. You can reach them by phone 410-825-8888 or www.sidran.org.
4.  Linda Foley
 Where are the resources- I cannot find them. Can you email them to me?
5.  V Sharp
 There are some resources posted on this site that I found very useful. I had people take the video tapes home. Doing a retreat or bringing folks in to do things like journaling, massage, meditation, drawing, sand trays, etc. is great. When people experience techniques they are more likely to use them in their personal life. We also created a wellness space in our office where we had new info and activities.
Return to Discussion