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What is compassion fatigue?

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Molly Siebenga

on 7 October 2014

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Transcript of What is compassion fatigue?

What is compassion fatigue?
Compassion fatigue is an emotional response which occurs within the professional, in response to the clinical material presented by clients.

It is a secondary trauma experienced by a professional as he/she engages with the traumatic stories of clients. It is suggested that it is the act of providing empathy, understood as entering or projecting oneself into the worldview of the client, which is the source of the trauma.

Lola's Needs:
How is this an issue for social workers?

Working In a Rural Setting

take into account; boundaries, networks, community, interrelatedness, past and present, transportation, self-reliance, local autonomy helping, traditions and institutions within her position
Social Work Metaphors
Within our work with Lola we may utilize 2 social work metaphors:
Compassion Fatigue
In Social work

Precipitating Factors
Perpetuating Factors
What are some of Lola’s roles as a social worker that have attributed to her compassion fatigue?
Social Work Metaphor : Mercenary
(Cost vs. Efficiency)
Predisposing Factors
Metaphor through the eyes of Lola
Struggle to meet agency standards within a specific time frame
Creates anxiety, stress and impacts performance
trying to maintain high level standard of practice with while trying to maintain a low cost
Results in Burnout
How can Lola move forward?
Community is the client
Lack of support
Multiple roles
More permeable boundaries, informal decision making, fewer resources etc.
Nature (Growth vs. Decay)
Disease (Health vs. Disease)
Struggle to advance while maintaining high output
Professional growth with lack of support
Is it an avenue of growth? Or is it straining?
From a medical model
severity may indicate course of action to assist Lola
Case Study
Manager and coworkers dismiss her feelings of stress and being overwhelmed.
Stress is manifesting itself in the form of illness.
Mercenary metaphor
No time for self care
Tense home life due to work stress
Doesn't feel like she fits in with the community
Lack of social services in her region due to size and remoteness of locations
Larger work load for Lola
Lack of support services for Lola

An element that causes or contributes to the occurrence of the issue. May not be the underlying cause, but rather what draws the issue out.
Courtney Bauman
Ivania Maldonado
Maria Langevin
Molly Siebenga

Lola is a 38 year old social worker who is currently employed with a family services program in a rural/remote Alberta community. Lola has been working in the social work field for the last 13 years and is currently experiencing compassion fatigue due to pressures and stress at work.
Lola is also experiencing some role duality because of lack of social service providers in her area.

Faces ethical dilemmas at work, because of dual relationships with community members and lack of resources, supervision, and agency support.

She has a hard time separating herself from her work:
This is partly because she has so much to do,
And partly because she is always seen as the social worker and therefore treated as a professional rather than a member in the community.

Because of her role with family services, some community members don’t see her as a helper, rather they see her as a threat who could take their children away.

Lola is originally from this community, but left to get her degree in social work. Upon coming back, she felt she was treated with distance because of her education.

Lola has tried talking to her manager and other coworkers about the stress she is under, but finds they just dismiss her feelings.

Her case loads are piling up, and she is putting in way too many hours at work. She was able to take some time off last year, which seemed to help, but feels she has too much on her plate at work for her to take any more time off.

Lola feels physically ill in the mornings, and dreads getting up to go to work.

Her stress has carried over to her home life, and making life tense between her and her partner.

Lately Lola has taking up drinking in the evenings, not heavily, but just enough so that she can wind down and sleep at night.

Lola understands the importance of self care, but doesn’t seem to be able to find the time. In the past Lola enjoyed yoga, and spending time out doors.

The need to maintain a job
Type A Personality
Stress and Pressures at Work
Personal life Factors
Interview with a social worker who has experienced burnout.
Don't let
it happen
to you!

compassion fatigue

• Exhaustion
• Reduced ability to feel sympathy and empathy
• Anger and irritability
• Increased use of alcohol and drugs
• Dread of working with certain clients/patients
• Diminished sense of enjoyment of career
• Disruption to world view, heightened anxiety or irrational fears
• Intrusive imagery or dissociation
• Hypersensitivity or Insensitivity to emotional material
• Difficulty separating work life from personal life
• Absenteeism – missing work, taking many sick days
• Impaired ability to make decisions and care for clients/patients
• Problems with intimacy and in personal relationships

Signs and
Symptoms of
(Forster, 2009)
Compassion Fatigue, Burnout, and Vicarious Trauma: Whats the difference?
Burn Out
"is a term that has been used since the early 1980s describe the physical and emotional exhaustion that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work...burnout can be fairly
easily resolved: changing jobs can provide
immediate relief to someone suffering from
job-related burnout".
Vicarious Trauma:
describes "the profound shift in world view that occurs in helping professionals when they work with clients who have experienced trauma: helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material".
Compassion Fatigue:
"Compassion Fatigue refers to the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate."
Lola’s lack of peer support is extremely difficult because they may also be feelings the same as she does. It’s probably not that they don’t care about Lola’s well being but that they may also be over worked and experiencing the same isolation and burn out as Lola. This inadequacy of peer support can also be part to Lola’s coworkers own incompetence and not wanting to be seen as if they are not caught up to do the job.

The geographic area where Lola lives prevents her just like the clients she serves to obtain proper resources to support her with her well being. This places Lola in parallel with her clients as she is also caught in the vicious cycle due to lack of resources in the area.

Lola acting on so many different roles creates hostility among her peers and community. Lola is involve in being an Educator, caseworker, case manager, works in small community, which creates hostility because her community does not know how to treat her
Increased alcohol consumption as result of stress

Her drinking is a symptom of isolation

Part of Lola’s drinking sounds like she has given up trying to deal with all the stress and alcohol relaxes her.

Lola’s emotional well being is manifesting serious signs of burn out, career loss and signs of causing more stress
Lola has no extended family near to support her or to speak with.

She is isolated in the community because of the work she does.

Her emotional mental health is at risk of preventing her from doing her work.

Lola is also affected by the stress level she is experiencing with her partner, adding a sense of isolation in her relationship

At this time Lola has no friends creating more isolation.

As a professional she has no outlet to support her or to speak of her stressors. This may create fear for Lola of losing her job and credibility in the community and among peers.

Continuum effect of Lola’s health breakdown
Continuum effect of Lola’s health breakdown
Lola's Micro
Addictions treatment services

Counseling services

Supports group through addictions

NA-Narcotic anonymous/AA alcoholic anonymous

Free counseling services through work

Peer support through work

Self care strategies
Society has an ideology that Lola has a perfect life, family, resources etc.

Community perceptions are unrealistic of Lola as it exceeds knowledge base and training that separates her from the rest of society.

Lola still experiences grief and loss, like everyone else. Except in a situation where burn out occurs she feel like she needs more work and dismisses the signs affecting her professional judgment and career.

The community and peers have a way of making Lola feel guilty for taking time off work when she doesn’t feel well. Part of this guilt could make Lola feel like she is letting the community or her peers down, embarrassed, ashamed.

Because of guilt Lola has taken on the extra work, masking her feelings to show everyone that she can do it

Rural community environment creates isolation, specially for Lola
Lola's Macro Needs:
Policy around stress services

Supervisors need to be open and willing an hear out suggestions when they express burn out symptoms

Add training supervisors and supporting staff on burn out

Agency support system that will stop the deterioration of the health of a burn out worker
Most rural communities have lack of tools for the job


Because of the lack of professionals some profession may cause the use of over power

In addition this environment may also cause for professional bullying to clients or towards other professionals

This power of the professional can lead to culture assuming that they take good care of themselves and letting their guard down.

Questioning her credibility
Her emotional credibility is declining and the quality of her work is creating chaos among community members and professionals

Dealing with Tensions
Lola’s is losing trust of peers and community and visa versa, reinforcing a sense of guilt and inadequacy among all

There may be question about work ethics

Clash with other professionals

The community might not take her serious as an educator, case manager or case worker

In rural areas relationships are closer together and information (gossip) travels faster and can create walls for any professional trying to help their clients
Lola's Mezzo Needs
Create a boundary where you cover the opposite community you live with the understanding you will eventually cross services. This way the client will not be so harshly impacted if the neighbour was a professional worker. This maintains confidentiality

Well establish confidentiality policy

Monthly meeting on discussion of challenges, resources, for whoever is experiencing burn out in the job

Create a buddy system with staff where you can bounce off concerns.

Counseling through internet
Anonymous (2014). Personal communication. [Audio File]

Blankenstein, T. (2014). Generalist practice in a rural/northern context [PowerPoint Slides]. Retrieved from http://d2l.ucalgary.ca/dsl/home

Bodor, R. (2009). The future for social work and mental health in rural and northern Canada.
Rural society
. 19(4), 289-292. Retrieved from http://rsj.e-contentmanagement.com/archives/vol/19/issues/3438/

Dorman, R. (2014). What's the best way to avoid "caregiver burnout"? [Video file]. Retrieved from http://www.facingdisability.com/expert-topics/whats-the-best-way-to-avoid-caregiver-burnout/robin-dorman-psyd

Forster, D. (2009). Rethinking Compassion Fatigue as Moral Stress.
Journal of Ethics in Mental Health
4(1). p. 1-4

Graham, J et al. (2011). Demographic, work-related, and life satisfaction predictors of northern social workers' satisfaction with work and profession.
International Social Work
, 56(5), 588-607. doi:10.1177/0020872811429953

Hamama, L. L. (2002). Burnout in social workers treating children as related to demographic characteristic, work environment and social support.
Social Work Research
, 36(2), 113-125

Humble, M et al. (2013). Challenges in rural social work practice: when support groups contain your neighbors, church members and the PTA.
Social Work With Groups
, 36(2), 249-258. doi:10.1080/0609513.2012.753807

Mathieu, F. (2013). What is Compassion Fatigue.
Compassion Fatigue Solutions
. Retrieved from https://compassionfatigue.ca/what-is-compassion-fatigue/

Portnoy, Dennis. (2014). Self-Care for Clinicians: Trauma, burnout and secondary stress.7-20. Retrieved from: http://psybc.com/pdfs/library/Self_Care_for_Clinicians.pdf

Pugh, R. (2007). Dual relationships: personal and professional boundaries in rural social work.
British Journal of Social Work.
2007(37), 1405-1423. doi:10.1093/bisw/bc1088

Rienbschleger, J.(2007). Social workers' suggestions for effective rural practice.
Families in Society,
88(2), 203-213. Retrieved from http://search.proquest.comezproxy.lib.ucalgary.ca/socialservices/advanced?accountid=9838

Schmidt, G. (2000). Remote, northern communities implications for social work practice.
International Social Work
, 43(3), 337-349. doi:10.1177/002087280004306

Schmidt, G. (008). Professional work in remote northern communities: a social work perspective.
The Community Development Institute
, 1-19. Retrieved from http://www.unbs.ca/assets/community_development_institute/g_schmidt_cdi_paper.pdf

Steyaert, Jan. (2010). The history of social work. Retrieved from: http://historyofsocialwork.org/eng/details.php?cps=6

Social Work class teaching.(2014). Urban vs. Rural Social Workers. Retrieved from: https://d2l.ucalgary.ca/d2l/le/content/16349/viewContent/866699/View

Tanchak, S. (2014). Gerenalist social work practice{lecture notes}. Retrieved from http://d2l.ucalgaary.ca/d2l/home

(Mathieu, 2013)
(Mathieu, 2013)
(Mathieu, 2013)
Continuum effect of Lola’s health breakdown
Compassion Fatigue &
Burn out Statistics
Connecting social work history to generalist social worker practice in northern rural community:
Ethical issues & dilemmas
Northern/ Rural/remote
Multifaceted social issues
Higher clientele caseload
In 1869, social work was associated with charities and voluntary assistance to the needy.

This idea originated in England and later on adopted in North America.
In 1889 a social work Pioneer Mary Ellen Richmond dedicated her life to modernize and professionalize care for individuals living in poverty. Mary started her career with the Charity Organization Society (COS) in a rural community called Baltimore located in east coast of United State of America.
In order to provide quality service Mary Richmond introduced social casework: to which she identified six sources of power that are available to clients and their social workers:
The source within the client's household
The source in client's neighborhood
The source client's wider social network
The source in civil agencies
The source in private agencies in the community
The source public agencies in the community

In today society Mary Richmond’s six sources method still widely being used in social work practice. In order to provide quality service Lola utilizes, Mary Richmond’s social casework method of investigation includes searching for resources in:
client's house hold
in the neighborhood
in the community
and in other private and public agencies
to satisfy clients’ needs in a northern rural community.
Mary Ellen
Mary constructed the foundations for the scientific methodology development of professional social work. She searched for the causes of poverty and social exclusion in the interaction between an individual and his or her environment.

Based on Mary Richmond's history to the present time social work practitioners have responsibilities in assisting individuals, families, groups and communities. Working hand in hand to empower clients in developing their own skills and abilities. To utilize their own and community resources to resolve social issues including: poverty, family violence, unemployment, addictions, child services and so on. To enhance client's individuality and collective well-being.
Educate Lola on the importance of self care in preventing compassion fatigue.
After assessing Lola's current self care practices, the next step will be to formulate a self care plan with Lola:
We will advocate to pursue social justice at mezzo and macro level for Lola.

Social Work
helping people work through their emotions, develop coping strategies, and adapt to their environments.
Under the role of a counselor :
we will carry on three roles including
in assisting Lola with her self-care plan.
According to Dennis’ Self-Care: Assessment example
Lola must consider the following 40 statements below. She can choose the number that best describes her and her current life circumstances. Please take a few minutes to complete this exercise before proceeding to the next step.
Responses: 1= Very True 2= Somewhat True 3= Rarely True 4= Not True

1. When people get upset, I try to smooth things out_____
2. I am not able to listen to other's problems without trying to 'fix" them and/or take away their
3. My self-worth is determined by how others perceive me____
4. When I am exposed to conflict, I feel it is my fault_______
5. I feel guilty when others are disappointed by my actions.
6. When I make a mistake, I tend to be extremely critical of myself: I have difficulty forgiving
7. I often do not know how I want other people to treat me______
8. I often find it difficult to tell people how I prefer to be treated_______
9. My achievements define my self-worth_______
10. I feel anxious in most situations involving confrontation_____
11. In relationships, it is easier for me to "give" that to "receive________
12. I can be so focused on someone I am helping that I lose sight of my own perceptions, interests and desires ______
13. It is hard for me to express vulnerable feelings_______
14. To make mistakes means that I am weak________
15. It is best to not "rock the boat" or "make waves______
16. It is important to put people at ease____
17. It is best that I do not need others________
If I cannot solve a problem, I feel like a failure_______
18. When I think about being firm with setting limits
19. I often feel "used up" at the end of the day________
20. I take work home frequently_______
21. I can ask for help but only if the situation is serious_______
22. I am willing to sacrifice my needs in order to please others______
23. When faced with uncertainty, I feel that things will get totally out of control______
24. I am uncomfortable when others do not see me as being strong and self-sufficient_______
25. In intimate relationships, I am drawn to people who are needy or need me________.
26. I have difficulty expressing my differing opinion in the face of an opposing
29. When I say "no", I often feel guilty_______.
30. When people I feel close to distance from me, I feel anxious_______
31. When listening to someone's problems I am more aware of their feelings than I am of my own feelings_______.
32. I find it difficult to stand up for myself and express my feelings when someone treats me in an insensitive manner______
33. I feel anxious when I am not busy______
34. I believe that expressing resentments is wrong______
35. I become anxious when I think I've disappointed someone______
36. Work dominates much of my life________
37. I seem to be working harder and accomplishing less_______.
38. I feel most worthwhile and alive in crisis situations______.
39. I have difficulty saying "no" and setting limits_______
40. My interests and values are primarily based on what others expect of me rather than from my values_______.
Self Care
Lola must acknowledge her limitations and acknowledge her level of tolerance.
Lola must identify and acknowledge the positive contribution she makes with the people she provides service too.
Lola must engage in activities that take her out of conceptual thinking and have nothing to do with work
These may include artistic activity, physical activities or being in nature.
Lola must take breaks and do not over schedule.
Lola must make time to spend with friends and family.
Lola must write in a journal on a daily basis
Lola must slow down and make time for leisure activity
(Portnoy, D. 2014. P.7-9).
At the mezzo level:
We advocate for Lola’s agency to provide healthy place where Lola can offer services and a place that is safe to provide a respectful service context for clients and their care providers. This will ensure low clients/staff turnover. The agency must provide fair system that benefits Lola and clients. This will encourage Lola to claim a voice in the agency decision making and empower her self-confidence.
At the macro level:
Advocate for more funding in the program. We will establish external social work professional supportive system for Lola.
Compassion fatigue and Burn out:
how does this differ in
rural/remote communities?
According to literature finding clarifies that northern rural remote community professional social workers are more likely in experience higher staffing turnover. Higher workload that contribute to stress, engage in dual relationships, self-reliant support system, lack of access to resources to provide quality service to the clients in need, distant communities and lack of privacy. Meanwhile, in urban centers professional social workers must engage in a formal role at work place, they must engage in detach relationship with clients, must follow guidelines set by ACSW, CASW and NACSW.
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