'We shield our heart with an armour woven out of very old habits of pushing away pain and grasping at pleasure. When we begin to breathe in (our) pain instead of pushing it away, we begin to open our hearts to what's unwanted. When we relate directly in this way to the unwanted areas of our lives, the airless room of ego begins to be ventilated.' Pema Chodron
Vicarious traumatization defined:
1. When people exposed to trauma experienced by those in their care become so overwhelmed that they themselves experience feelings of fear, pain, and suffering including intrusive thoughts, nightmares, loss of energy, and perception of threats at home or at work.
2. An extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper.
3. When a carer with previously benign yet pre-existing traumatic injury, experiences onset of their own trauma symptoms when exposed to the trauma of those in their care. This is a synergistic relationship between primary traumatic stress, secondary or vicarious trauma and burn out.
Avoiding burnout syndrome for psychotherapists with high case load inattention, emotional exhaustion, depersonalisation, isolation and doubt that may account for the intentions of many health workers to leave the field and not return
Helping others puts you in direct contact with other people's lives. As you probably have experienced, your compassion for those you help has both positive and negative aspects. This self -test helps you estimate your compassion status: How much at risk you are of burnout and compassion fatigue and also the degree of satisfaction with your helping others. Consider each of the following characteristics about you and your current situation. Write in the number that honestly reflects how frequently you experienced these characteristics in the last week. Then follow the scoring directions at the end of the self-test. 0=Never 1=Rarely 2=A Few Times 3=Somewhat Often 4=Often 5=Very Often
Items About You
1. I am happy.
2. I find my life satisfying.
3. I have beliefs that sustain me.
4. I feel estranged from others.
5. I find that I learn new things from those I care for.
6. I force myself to avoid certain thoughts or feelings that remind me of a frightening experience.
7. I find myself avoiding certain activities or situations because they remind me of a frightening experience.
8. I have gaps in my memory about frightening events.
9. I feel connected to others.
10. I feel calm.
11. I believe that I have a good balance between my work and my free time.
12. I have difficulty falling or staying asleep.
13. I have outburst of anger or irritability with little provocation
14. I am the person I always wanted to be.
15. I startle easily.
16. While working with a victim, I thought about violence against the perpetrator.
17. I am a sensitive person.
18. I have flashbacks connected to those I help.
19. I have good peer support when I need to work through a highly stressful experience.
20. I have had first-hand experience with traumatic events in my adult life.
21. I have had first-hand experience with traumatic events in my childhood.
22. I think that I need to "work through" a traumatic experience in my life.
23. I think that I need more close friends.
24. I think that there is no one to talk with about highly stressful experiences.
25. I have concluded that I work too hard for my own good.
26. Working with those I help brings me a great deal of satisfaction.
27. I feel invigorated after working with those I help.
28. I am frightened of things a person I helped has said or done to me.
29. I experience troubling dreams similar to those I help.
30. I have happy thoughts about those I help and how I could help them.
31. I have experienced intrusive thoughts of times with especially difficult people I helped.
32. I have suddenly and involuntarily recalled a frightening experience while working with a person I helped.
33. I am pre-occupied with more than one person I help.
34. I am losing sleep over a person I help's traumatic experiences.
35. I have joyful feelings about how I can help the victims I work with.
36. I think that I might have been "infected" by the traumatic stress of those I help.
37. I think that I might be positively "inoculated" by the traumatic stress of those I help.
38. I remind myself to be less concerned about the well being of those I help.
39. I have felt trapped by my work as a helper.
40. I have a sense of hopelessness associated with working with those I help.
41. I have felt "on edge" about various things and I attribute this to working with certain people I help.
42. I wish that I could avoid working with some people I help.
43. Some people I help are particularly enjoyable to work with.
44. I have been in danger working with people I help.
45. I feel that some people I help dislike me personally.
Items About Being a Helper and Your Helping Environment
46. I like my work as a helper.
47. I feel like I have the tools and resources that I need to do my work as a helper.
48. I have felt weak, tired, run down as a result of my work as helper.
49. I have felt depressed as a result of my work as a helper.
50. I have thoughts that I am a "success" as a helper.
51. I am unsuccessful at separating helping from personal life.
52. I enjoy my co-workers.
53. I depend on my co-workers to help me when I need it.
54. My co-workers can depend on me for help when they need it.
55. I trust my co-workers.
56. I feel little compassion toward most of my co-workers
57. I am pleased with how I am able to keep up with helping technology.
58. I feel I am working more for the money/prestige than for personal fulfillment.
59. Although I have to do paperwork that I don't like, I still have time to work with those I help.
60. I find it difficult separating my personal life from my helper life.
61. I am pleased with how I am able to keep up with helping techniques and protocols.
62. I have a sense of worthlessness/disillusionment/resentment associated with my role as a helper.
63. I have thoughts that I am a "failure" as a helper.
64. I have thoughts that I am not succeeding at achieving my life goals.
65. I have to deal with bureaucratic, unimportant tasks in my work as a helper.
Scoring Instructions Please note that research is ongoing on this scale and the following scores should be used as a guide, not confirmatory information. 1. Be certain you respond to all items. 2. Mark the items for scoring: a. Put an x by the following 26 items: 1-3, 5, 9-11, 14, 19, 26-27, 30, 35, 37, 43, 46-47, 50, 52-55, 57, 59, 61, 66. b. Put a check by the following 16 items: 17, 23-25, 41, 42, 45, 48, 49, 51, 56, 58, 60, 62-65. c. Circle the following 23 items: 4, 6-8, 12, 13, 15, 16, 18, 20-22, 28, 29, 31-34, 36, 38-40, 44. 3. Add the numbers you wrote next to the items for each set of items and note: a. Your potential for Compassion Satisfaction (x): 118 and above=extremely high potential; 100-117=high potential; 82-99=good potential; 64-81=modest potential; below 63=low potential. b. Your risk for Burnout (check): 36 or less=extremely low risk; 37-50=moderate risk; 51-75=high risk; 76-85=extremely high risk. c. Your risk for Compassion Fatigue (circle): 26 or less=extremely low risk, 27-30=low risk; 31-35=moderate risk; 36-40=high risk; 41 or more=extremely high risk. Professional Resource Information
NOTE: URLs are given beside references rather than linked to the document name so that they can be read from print copy.
The Compassion Fatigue Scale has been established, presented, and published in several articles/chapters including, among others, the following:
Clemens, Lisa Ace. (1999). Secondary traumatic stress in rape crisis counselors: a descriptive study [thesis]. California State University, Fresno, M.S. thesis; Masters Abstracts 37/06: 1965. Figley, C. R. (1998). Burnout as systemic traumatic stress: a model for helping traumatized family members. In C. R. Figley (ed.). Burnout in families: the systemic costs of caring, pp. 15-28. Boca Raton, Florida: CRC Press. Figley, C.R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner Mazel. http://www.opengroup.com/open/dfbooks/087/0876307594.shtml. Figley, C.R. (1999). Compassion Fatigue. In B. H. Stamm, (Ed.) Secondary traumatic stress: Self-care issues for clinicians, researchers and educators, 2nd Ed. Lutherville, MD: Sidran Press. http://www.sidran.org/digicart/products/stss.html. Garrett, Carol. (1999). Stress, coping, empathy, secondary traumatic stress and burnout in healthcare providers working with HIV-infected individuals [dissertation]. New York University, Ph.D. dissertation; Dissertation Abstracts International 60/04-A: 1329. Good, D. A. (1996). Secondary traumatic stress in art therapists and related mental health professionals [dissertation]. University of New Mexico, Ph.D. dissertation; Dissertation Abstracts International 57/06-A: 2370. Landry, L. P. (1999). Secondary traumatic stress disorder in the therapists from the Oklahoma City bombing [dissertation]. University of North Texas, 1999. Ortlepp, K. Friedman, M. (2001). The relationship between Sense of Coherence and indicators of secondary traumatic stress in non-professional trauma counsellors. South African Journal of Psychology, (31) 2, 38-45 (2001). Rudolph, J.M, Stamm, B.H., & Stamm, H.E. (November, 1997). Compassion Fatigue: A Concern for Mental Health Policy, Providers and Administration. Poster presented at the 13th Annual Conference of the International Society for Traumatic Stress Studies, Montreal, ON, CA. http://www.isu.edu/~bhstamm/ISTSS97cf.PDF. Salston, M. G. (2000). Secondary traumatic stress: a study exploring empathy and the exposure to the traumatic material of survivors of community violence [dissertation]. The Florida State University, 2000. Stamm, B. H. (in press). Measuring Compassion Satisfaction as Well as Fatigue: Developmental History of the Compassion Fatigue and Satisfaction Test. In C.R. Figley (Ed.). Treating Compassion Fatigue. Philadelphia: Brunner/Mazel. Stamm, B.H. (April 1997). Mental Health Research in Telehealth. Invited address at From Research to Practice: A Conference on Rural Mental Health Research, National Institute of Mental Health. Oxford MS. White, Geoffry D. (1998). Trauma treatment training for Bosnian and Croatian mental health workers. American Journal of Orthopsychiatry 68 (1), pp. 58-62.
There is a psychometric review in: Figley, C.R. & Stamm, B.H. (1996). Psychometric Review of Compassion Fatigue Self Test http://www.isu.edu/~bhstamm/pdf/figleystamm.pdf. In B.H. Stamm (Ed), Measurement of Stress, Trauma and Adaptation. Lutherville, MD: Sidran Press http://www.sidran.org/dicart/products/stss/html. For general information on Secondary Traumatic Stress/Vicarious Traumatization/Compassion Fatigue: Pearlman, L. et al. (2000). Traumatic Stress Institute & Center for Adult & Adolescent Psychotherapy, LLC Web Site http://www.tsicaap.com. Pearlman, L, et al. (1999). Risking Connections. Sidran Press. http://www.riskingconnection.com/ Pearlman, L. Saakvitne, K. (1995). Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New York: WW Norton. http://web.wwnorton.com/catnos/tl070183.htm. Figley, C.R. (1998). Traumatology E-Journal Web Site. http://psy.uq.edu.au/PTSD/trauma/j1.html. Stamm, B.H. (1999). Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers and Educators, 2nd Ed. Lutherville, MD: Sidran Press. http://www.sidran.org/digicart/products/stss.html. Stamm, B.H. (1999). Creating virtual community: Telehealth and self-care updated. In B.H. Stamm. (Ed.), Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers and Educators, 2nd Ed. Lutherville, MD: Sidran Press. http://www.isu.edu/~bhstamm/vircom.htm. Stamm, B.H. (1997). Work-related Secondary Traumatic Stress. PTSD Research Quarterly,(8) 2, Spring. http://www.isu.edu/dms/ptsd/RQ_Spring_1997.html. Stamm, B.H. (1997). Work-related Secondary Traumatic Stress (reprint). Anxiety Disorders Association of America Reporter Summer/Fall. Stamm, B. H. (1998). Rural-Care: Crossroads of Health Care, Culture, Traumatic Stress & Technology Web Site http://www.isu.edu/~bhstamm/index.htm. Stamm, B. H. (1998). Traumatic Stress Secondary Traumatic Stress Web Site. http://www.isu.edu/~bhstamm/ts.
The psychometric information reported here is based on a pooled sample of 370 people. Multivariate analysis of variance did not provide evidence of differences based on country of origin, type of work, or sex when age was used as a control variable.
Age Sex Type of Work Country of Origin Mean 35.4 Males n=121 (33%) Trauma Professional n=58 (16%) USA Rural-Urban mix n=160 (43%) Median 36 Females n=207 (56%) Business volunteer n=130 (35%) Canada-Urban n=30 (8%) SD 12.16 Unknown n=42 (11%) Red Cross n=30 (8%) South Africa-Urban n=130 (35%)
Caregivers in training n=102 (27%) Internet (unknown origin) n=50 (13%)
Scale Alpha Mean Standard Deviation Interpretation Compassion Satisfaction .87 92.10 16.04 higher is better satisfaction with ability to caregiver (e.g. pleasure to help, like colleagues, feel good about ability to help, make contribution, etc.) Burnout .90 24.18 10.78 higher is higher risk for burnout (feel hopeless and unwilling to deal with work, onset gradual as a result of feeling one's efforts make no difference or very high workload) Compassion Fatigue .87 28.78 13.15 higher is higher risk for Compassion Fatigue (symptoms of work-related PTSD, onset rapid as a result of exposure to highly stressful caregiving)
Additional Information: Lay Mental Health Caregivers in Rural Africa (n=16) (note, compassion satisfaction subscale was not given). First assessment (min 3 months work) CF Mean 45 (SD 14.4) BO Mean 32 (SD 11.3) Second assessment (3 months later) CF Mean 44 (SD 13.6) BO Mean 28.86 (SD 9.6)
Some thoughts from Bill O'Hanlon on writing about life crises
"Writing thoughts and feelings about trauma or crises for as little as 15 minutes a day for as few as four or five days has been shown to be correlated with: -Far fewer visits to the student health center for college students -An increase in T-cells (immune system functioning) -Increasing the likelihood and rapidity of getting a new job after being laid off -Reduced anxiety and depression -Improved grades -Improved mental and physical health of grade-school students, people in nursing homes, arthritis patients, medical students, rape victims, new mothers, and prisoners
How to do the writing ritual: 1. Write honestly and openly about your deepest feelings and thoughts about the situation you are in or went through. Make sure you keep these writings private or you may find yourself unconsciously censoring what you write and diluting the effects of the writing. Consider destroying what you wrote after it is complete, again for the same reason. Perhaps making a ritual of the burning or destroying of the writing. (See the next section of this chapter for some hints about doing that kind of ritual.) 2. Write for a relatively short time, say 15 minutes. This writing is often draining or emotionally difficult. Limiting the time makes it both a bit more tolerable and more likely that you will do it. 3. Write for only four or five days. This time limit seemed to work very well in the experiments that were done. They are not carved in granite, however, and if you find you need more time, you can take it. One of the points of this limit of a few days is again to contain the experience so it doesn,t take over your life. 4. Try to find both a private and unique place to write, somewhere you can both be uninterrupted and someplace that won,t be associated with other things or that have the usual smells, sights and sounds of places you already know well. 5. Don,t worry about grammar or spelling or getting it right. Just write. 6. During the writing days, try to use the same time each day or evening to write. It,s not crucial, but it can sometime give your unconscious mind some structure and preparation time if it knows exactly when the writing will take place. This can also help contain the emotions and intrusive thinking that may occur and interfere with your day or evening 7. Writing seems to be the most powerful, but if for some reason, that won,t work for you, you could try "writing by speaking into a tape recorder or a video camera. 8. Ignore these guidelines if you discover something else works better for you. Everyone is unique.
Sources: Opening Up: The Healing Power of Expressing Emotions, James Pennebaker, NY: Guilford, 1990. The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being, eds. Stephen J. Lepore and Joshua M. Smyth, APA: Washington, DC, 2002."
Bill O'Hanlon, M.S., Possibilities 551 Cordova Rd., #715 Santa Fe, NM 87505 800.381.2374, Fax# 505.983.2761 PossiBill@aol.com, www.brieftherapy.com
MINDFULNESS
Ancient Pali texts liken meditation to the process of taming a wild elephant. The procedure in those days was to tie a newly captured animal to a post with a good strong rope. When you do this, the elephant is not happy. He screams and tramples, and pulls against the rope for days. Finally it sinks through his skull that he can’t get away, and he settles down. At this point you begin to feed him and to handle him with some degree of safety. Eventually you can dispense with the rope and post altogether, and train your elephant for various tasks. Now you’ve got a tamed elephant that can be put to useful work. In this analogy the wild elephant is your wildly active mind, the rope is mindfulness, and the post is our object of meditation, our breathing. The tamed elephant who emerges from this process is a well-trained, concentrated mind that can then be used for the exceedingly tough job of piercing the layers of illusion that obscure reality. Meditation tames the mind. Henepola Gunaratna, 'Mindfulness in Plain English'
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