1. Compassion Fatigue
Secondary Trauma
What is it?

2. History
 1982: Charles Figley defines SecondaryTraumatic
Stress as a phenomenon associated with the “cost of
caring”
 1992: Nurse Joinson used term in Nursing Magazine to
describe feeling of “worn down”
 1992: Jeffrey Kottler writes CompassionateTherapy to
emphasize importance of compassion when dealing with
difficult / resistant clients
 1995: Figley redefines SecondaryTraumatic Stress to a
“more friendly term” - Compassion Fatigue

3. CF defined:
 Those who work with the suffering
suffer themselves because of the work
 “We absorb the traumatic stress
of those we help” (Beaton & Murphy, 1995)

4. AKA Secondary Trauma
or Secondary Post-Traumatic Stress
or Secondary Exposure
or SecondaryVictimization
orVicariousTraumatization
or Emotional Contagion
or Secondary Survivor
“Phenomenon associated with the
‘cost of caring’ for others in emotional pain”
(Figley, 1982)

5. Compassion Fatigue
Secondary Trauma
Do I have it?

6. CF “Possible” Solution…

7. Compassion Fatigue
Secondary Trauma
How did I get it?

8. The CF Process
Figley, 2001

9. The CF Process
1. Exposure to Suffering
2. Empathic Concern – motivation to respond to
those in need
3. Empathic Ability – aptitude for noticing the pain of
others
4. Empathic Response – helper makes an effort to
reduce the suffering of the sufferer

10. The CF Process
5. Compassion stress – compulsive demand for
action to relieve the suffering of others
6. Prolonged Exposure – on-going sense of
responsibility for the care of the suffering
7. Traumatic recollections – memories that trigger
the symptoms of PTSD
8. Demands of Life – unexpected changes in
schedule, routine, & managing life’s responsibilities that
demand attention

11. The CF Process
9. Compassion Fatigue – state of tension and
preoccupation with the traumatized by:
a. Re-experiencing the traumatic events
b. Avoidance/numbing reminders
c. Persistent arousal
9. CompassionTrap – inability to let go of the
thoughts, feelings and emotions useful in helping
another, long after they are useful

12. A
Codependent
Co-worker
with
Compassion
Fatigue

13. Compassion Fatigue
Secondary Trauma
How bad is it?

14. Contributing Factors
 Intensity
 Frequency
 Severity
 Proximity
 Personal Factors
 Sensory Information
– “Imprint of Horror”
(Learner, 2005)
 Perceptions,
Belief system
 Current coping
mechanisms
 Implementation of
self-care techniques
 Support system

15. Symptoms of Poor Self-Care
 Cognitive
 Diminished
concentration
 Confusion
 Loss of meaning
 Decreased of
self-esteem
 Apathy
 Rigidity
 Self-doubt
 Perfectionism
 Minimization

16. Symptoms of Poor Self-Care
 Emotional
 Powerlessness
 Anxiety
 (Survivor) Guilt
 Anger/rage
 Numbness
 Fear
 Sadness
 Helplessness
 Depression
 Hypersensitivity
 Overwhelmed
 Depleted

17. Symptoms of Poor Self-Care
 Behavioral
 Impatient
 Withdrawn
 Moody
 Regression
 Sleep Disturbances
 Appetite changes
 Elevated startled
response
 Hyper vigilance
 Use of unhealthy coping
skills
 Accident proneness
 Losing things
 Self-harm behaviors

18. Symptoms of Poor Self-Care
 Spiritual
 Questioning the meaning of life
 Loss of purpose
 Lack of self-satisfaction
 Pervasive hopelessness
 Angry at God
 Questioning prior beliefs
 “Soul Sick” (Bill O’Hanlon)

19. Symptoms of Poor Self-Care
 Interpersonal
 Withdrawn
 Decreased interest in intimacy
 Mistrust
 Intolerance
 Loneliness
 Projection of anger or blame

20. Symptoms of Poor Self-Care
 Physical
 Shock
 Sweating
 Rapid heartbeat
 Aches and pains
 Dizziness
 Impaired immune system
 Restlessness

21. Impact on Professional
Functioning
 Performance of JobTasks
 Decrease in quality & quantity
 Low motivation
 Avoidance of job tasks
 Increased mistakes
 Setting perfectionist standards
 Obsession about details

22. Impact on Professional
Functioning
 Morale
 Decrease in confidence
 Loss of interest
 Dissatisfaction
 Negative attitude
 Apathy
 Demoralization
 Lack of appreciation
 Detachment
 Feelings of
incompleteness

23. Impact on Professional
Functioning
 Interpersonal
 Withdrawal from colleagues
 Impatience
 Decrease in quality of relationship
 Poor communication
 Staff conflicts

24. Impact on Professional
Functioning
 Behavioral
 Absenteeism
 Exhaustion
 Faulty judgment
 Irritability
 Tardiness
 Irresponsibility
 Overwork
 Frequent job changes

25. Compassion Fatigue
Secondary Trauma
How do I
get rid of it?

26. “When you discover you are
riding a dead horse,
the best strategy
is to dismount”
- Dakota Tribal Saying

27. ““Primum non nocere”Primum non nocere”
- Claudius Galen, born in 129 AD, chief physician
to the gladiator school in Pergamum
First Do No HarmFirst Do No Harm

28. ““First do no harmFirst do no harm
to Self”to Self”
- Gentry & Figley, 2007
Created adage after discovering correlation between
compassion fatigue and ethical violations

29. Self-Care may involve…
 Re-evaluating an unhealthy relationship
 Listening to your body & staying within your limits
 Advocating for your rights
 Commit more time to planning
 Not assuming responsibility for others & their
problems
 Lose “all-or-nothing” thinking; be more flexible
 Not feeling compelled to “fix”/solve another
person’s problem
 Not anticipate the needs of others

30. Self-Care may involve…
 Re-think trying to please others; explore being
satisfied with self
 Appreciate your mistakes – opportunity to learn &
grow
 Not over-committing
 Giving yourself plenty of time so you don’t feel
harried or pressured
 Quit blaming and shaming self…then others
 Stop taking things personally

31. Self-Care may involve…
 Keeping up with dentist & doctors appts.
 Taking restroom breaks when needed
 Accepting myself for who I am
 Not feeling the need to control; accept some
things are out of my control
 Forgive yourself when you make a mistake
 Quit trying to prove you’re good enough
 Stop tolerating behaviors that you don’t want to
tolerate
 Trust yourself

32. Compassion Fatigue
Secondary Trauma
How do I keep it
from coming back?

34. Back to the CF Process
 Detachment (M. Beattie, 1992)
 Opposite of attachment – excessively worried or
preoccupied w/ person or problem
 It’s Not: Cold,Withdrawn, Hostile, Ignorant Bliss
 Based on premise that “each person is responsible
for himself & we can’t solve problems that aren’t
our own & worrying doesn’t help”

35. Detachment cont.
 “It doesn’t mean we don’t care. It means we
learn to love, care & be involved without
going crazy” (M. Beattie, 1992)
 “When we allow people to be who they
are, then we stop trying to change things
we can’t.” (M. Beattie, 1992)

36. Sense of Satisfaction
 “Shades of Gray” (D. Burns, 2005, Cognitive Motivational
Therapy)
 “When things don’t work out as well as you’d
hoped, you can think of the experience as a partial
success or learning opportunity.
 Question: Are you wanting your client to
provide for you a sense of satisfaction?
 “You’re OK … then I’m OK”

37. Sense of Satisfaction cont.
 Reframe the “Pay-Out”
 Appreciation
 Approval
 Attention
 Acceptance
 Affiliation
 Admiration
 Acknowledgement
 Affirmation
 Accomplishment
 Affection

38. Standards of Self-Care
1. Respect for dignity & worth of self
2. Responsible for self-care
3. Universal right to wellness
4. Physical rest, emotional rest & nourishment
5. Seek, find & remember appreciation from
supervisors & clients
6. Make it known that you wish to be
recognized for your service
Adapted from “Standards of Self Care for the Practitioner,” Green Cross Foundation, Inc., 2004