2010

TheConciseProQOLManual

BethHudnallStamm,PhD
Proqol.org

BethHudnallStamm.comand
CompassionSatisfactionAndCompassionFatigue.com
TheConciseProQOLManual,2ndEdition

Reference
Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID:
ProQOL.org.

Copyright Beth Hudnall Stamm. All rights reserved.

12345679890

Published The ProQOL.org, P.O. Box 4362. Pocatello, ID 83205-4362

Cover design by Beth Hudnall Stamm
Images copyright 2008 Henry E. Stamm, IV
Printed in Trebuchert MS font for the headers and 11 point Calibrifontforthebody.

ISSN to be applied for

Reference
Stamm, B.H. (2010). The Concise ProQOL Manual. Pocatello, ID: ProQOL.org.

Acknowledgements

IhereprovideacknowledgementsfortheirfaithfulcontributionstothedevelopmentoftheProQOL
gotoJosephM.Rudolph,EdwardM.Varra,KellyDavis,DebraLarsen,CraigHigsonSmith,AmyC.
Hudnall,HenryE.Stamm,andtoallthosefromaroundtheworldwhocontributedtheirrawdatato
thedatabank.IamforeverindebtedtoCharlesF.Figleywhooriginatedthescale,andin1996,

SECTION1:COMPASSIONSATISFACTIONANDCOMPASSIONFATIGUE

Professionalqualityoflifeisthequalityonefeelsnrelationtotheirworkasahelper.Boththepositiveand
negativeaspectsofdoingonesjobinfluenceonesprofessionalqualityoflife.Peoplewhoworkinhelping
professionsmayrespondtoindividual,community,national,andeveninternationalcrises.Helperscanbe
foundinthehealthcareprofessionals,socialserviceworkers,teachers,attorneys,policeofficers,firefighters,
clergy,airlineandothertransportationstaff,disastersitecleanupcrews,andotherswhoofferassistanceat
thetimeoftheeventorlater.

Professionalqualityoflifeincorporatestwoaspects,thepositive(CompassionSatisfaction)andthenegative
(CompassionFatigue).Compassionfatiguebreaksintotwoparts.Thefirstpartconcernsthingssuchlike
exhaustion,frustration,angeranddepressiontypicalofburnout.SecondaryTraumaticStressisanegative
feelingdrivenbyfearandworkrelatedtrauma.Sometraumaatworkcanbedirect(primary)trauma.Inother
cases,workrelatedtraumabeacombinationofbothprimaryandsecondarytrauma.

FIGURE1:DIAGRAMOFPROFESSIONALQUALITYOFLIFE

ProfessionalQualityofLife

Compassion Compassion
Satisfaction Fatigue

Secondary
Burnout
Trauma

BACKGROUND

Professionalqualityoflifeforthoseprovidingcarehasbeenatopicofgrowinginterestoverthepasttwenty
years.Researchhasthatshownthosewhohelppeoplethathavebeenexposedtotraumaticstressorsareat
riskfordevelopingnegativesymptomsassociatedwithburnout,depression,andposttraumaticstress
disorder.Inthisbodyofliterature,typicallyknownassecondarytraumatizationorvicarioustraumatization,
thepositivefeelingsaboutpeoplesabilitytohelpareknownasCompassionSatisfaction(CS).Thenegative,
secondaryoutcomeshavevariouslybeenidentifiedasburnout,countertransference,CompassionFatigue(CF)
andSecondaryTraumaticStress(STS),andVicariousTraumatization(VT).

Whiletheincidenceofdevelopingproblemsassociatedwiththenegativeaspectsofprovidingcareseemsto
below,theyareseriousandcanaffectanindividual,theirfamilyandcloseothers,thecaretheyprovide,and
theirorganizations.Thepositiveaspectsofhelpingcanbeviewedasaltruism;feelinggoodthatyoucando
somethingtohelp.Thenegativeeffectsofprovidingcareareaggravatedbytheseverityofthetraumatic
materialtowhichthehelperisexposed,suchasdirectcontactwithvictims,particularlywhentheexposureis
ofagrotesqueandgraphicnature.Theoutcomesmayincludeburnout,depression,increaseduseof
substances,andsymptomsofposttraumaticstressdisorder.

In1995,threebooksintroducedtheconceptsofthenegativeeffectsoncaregiverswhoprovidecaretothose
whohavebeentraumatized.123Theterminologywasatthattime,andcontinuestobe,ataxonomical
conundrum.However,sincethattime,Figley,Stamm,andPearlmantogetherhaveproducedover50
additionalscientificwritingsonthetopic.Castingabroadnetacrossthetopic,over500papers,booksand
articleshavebeenwritten,includingnearly200peerreviewedpapers,130dissertationsalongwithvarious
unpublishedstudies.Amongwhichthereareandahundredresearchpapersusingatypeofmeasurementof
thenegativeeffectsofsecondaryexposuretotraumaticstress.Researchhasbeenconductedacrossmultiple
culturesworldwide,andacrossmultipletypesoftraumaticeventexposures.

Asnotedabove,thereareissuesassociatedwiththevarioustermsusedtodescribenegativeeffects.There
arethreeacceptedterms:compassionfatigue,secondarytraumaticstress,andvicarioustrauma.Theredo
seemtobenuancesbetweenthetermsbutthereisnodelineationbetweenthemsufficienttosaythatthey
aretrulydifferent.Therehavebeensomepapersthathavetriedtoferretoutthespecificdifferencesbetween
thenamesandtheconstructs.4Thesepapershavebeenlargelyunsuccessfulinidentifyingrealdifferences
betweentheconceptsaspresentedundereachname.Thethreetermsareusedoften,eveninwritingthat
combinesFigley(compassionfatigue),Stamm(secondarytraumaticstress)andPearlman(vicarious
traumatization).Thevariousnamesrepresentthreeconverginglinesofevidencethatproducedthree
differentconstructnames.Asthetopichasmatured,reconfigurationofthetermsseemstimely.

Ingeneral,lookingbeyondissuesoftaxonomy,therehasbeenlittlenegativecritiqueofthetopicasawhole.
Nonetheless,therearearticlesthatquestioninitsentiretytheconceptofsecondarynegativeeffectsdueto
workwithpeoplewhohavebeentraumatized.56Botharticlespointtoalackofresearch,perhapsallowablein
somepartgiventhenascentnatureoftheconstruct,particularlyintheArvaypaper,whichwaspublishedin
2001.Fouryearslater,atthecoreofKadambi&Ennis(2005)suggestiontoreexaminethecredibilityofthe
topicaremeasurementissues,thatis,refineddefinitionsofthecharacteristicsandreliableandvalidmeasures
oftheconstructs.Thesecritiquesseemwellearnedatthepointthattheywerewritten.Whetherinresponse
tothecritiques,orasnaturalevolution,overhalfoftheresearcharticlesthatexistwerewrittenafterthese
critiquesreviewswereconducted.Inaddition,astheauthorspointedout,therewerevariedmeansof
assessingthenegativeeffects.

Basedonexperienceandsomeresearch,organizationalpreventionprogramsarebelievedtohelpmaximize
helperswellbeing(CS)andreducetherisksfordevelopingcompassionfatigueandsecondarytrauma.Ata
minimum,organizationalprogramsshowtheworkerthattheyhaveformallyaddressedthepotentialforthe
worktoaffecttheworker.Goodprogramsdonotidentifytootherworkersorsupervisors,specificinformation
abouttheworker'sprofessionalqualityoflifeunlesstheinformationissharedbytheworker.Insomecases,

1
Figley,C.R.(Ed.)(1995).Compassionfatigue:Copingwithsecondarytraumaticstressdisorderinthosewhotreatthetraumatized.New
York:Brunner/Mazel.
2
Pearlman,L.A.,&Saakvitne,K.W.(1995).Traumaandthetherapist:Countertransferenceandvicarioustraumatizationinpsychotherapy
withincestsurvivorsNewYork:Norton.
3
Stamm,B.H.(.Ed).(1995).Secondarytraumaticstress:Selfcareissuesforclinicians,researchers,andeducators.Maryland:SidranPress:
Lutherville.
4
cfBaird,K.,&Kracen,A.C.(2006).Vicarioustraumatizationandsecondarytraumaticstress:Aresearchsynthesis.Counselling
PsychologyQuarterly,19(2),181188.
5
Kadambi,M.A.,&Ennis,L.(2004).Reconsideringvicarioustrauma:Areviewoftheliteratureandits'limitations.JournalofTrauma
Practice,3(2),121.
6
Arvay,M.J.(2001).Secondarytraumaticstressamongtraumacounsellors:Whatdoestheresearchsay?InternationalJournalforthe
AdvancementofCounselling,23(4),283293.

supervisorsaddressperformanceissuesthattheybelievemaybenegativeaspectsofhelpingbutinthose
cases,theprincipalsoforganizationalhumanresourcessuggestthattheseperformanceissuesshouldbe
handledassuch,notasaflawinthecharacteroftheemployee,butaperformanceissue.

Theoverallconceptofprofessionalqualityoflifeiscomplexbecauseitisassociatedwithcharacteristicsofthe
workenvironment(organizationalandtaskwise),theindividual'spersonalcharacteristicsandtheindividual's
exposuretoprimaryandsecondarytraumaintheworksetting.Thiscomplexityappliestopaidworkers(e.g.
medicalpersonnel)andvolunteers(e.g.RedCrossdisasterresponders).

ThediagrambelowhelpsillustratetheelementsofProfessionalQualityofLife.Inthecenterofthediagram
arecompassionsatisfactionandcompassionfatigue.CompassionSatisfactionisthepositiveaspectsofhelping
othersandCompassionSatisfactionarethenegativeone.Ascanbeseen,oneworkenvironment,client(or
thepersonhelped)environmentandthepersonsenvironmentallhavearolltoplay.Forexample,apoor
workenvironmentmaycontributetoCompassionFatigue.Atthesametime,apersoncouldfeelcompassion
satisfactionthattheycouldhelpothersdespitethatpoorworkenvironment.CompassionFatiguecontains
twoverydifferentaspects.Bothhavethecharacteristicofbeingnegative.However,workrelatedtraumahas
adistinctiveaspectoffearassociatedwithit.Whileitismorerarethanoverallfeelingsofwhatwecancall
burnout,itisverypowerfulinitseffectonaperson.Whenbothburnoutandtraumaarepresentinapersons
lifetheirlifecanbeverydifficultindeed.Thediagrambelowshowsatheoreticalpathanalysisofpositiveand
negativeoutcomesofhelpingthosewhohaveexperiencedtraumaticstress.

FIGURE2:THEORETICALPATHANALYSIS

10

Fourscalesemergedintheearlyresearch.Twoofthem(theImpactofEventScaleandtheTraumaticStress
InstituteBeliefScale)werenotspecifictosecondaryexposure.Theywereusedequallyforpeoplewhowere
thedirectvictimsoftraumaaswellasforthosewhoweresecondarilyexposedintheirroleashelpers.78Two
measuresemergedasspecificmeasuresforsecondaryexposure.TheCompassionFatigueTestinitsvarious
versions9101112andtheSecondaryTraumaticStressScale.13

TheProfessionalQualityofLifeScale,knownastheProQOL,isthemostcommonlyusedmeasureofthe
positiveandnegativeeffectsofworkingwithpeoplewhohaveexperiencedextremelystressfulevents.Ofthe
100papersinthePILOTSdatabase(thePublishedLiteratureinPosttraumaticStressDisorder),46useda
versionoftheProQOL.ThemeasurewasoriginallycalledtheCompassionFatigueSelfTestanddevelopedby
CharlesFigleyinthelate1980sStammandFigleybegancollaboratingin1988.In1993,Stammaddedthe
conceptofcompassionsatisfactionandthenameofthemeasurechangedtotheCompassionSatisfactionand
FatigueTest,ofwhichtherewereseveralversions.Theseversionsintheearly1990swereFigleyandStamm,
thenStammandFigley.ThroughapositivejointagreementbetweenFigleyandStammthemeasureshifted
entirelytoStamminthelate1990sandwasrenamedtheProfessionalQualityofLifeScale.TheProQOL,
originallydevelopedinEnglish,istranslatedintoFinnish,French,German,Hebrew,Italian,Japanese,Spanish,
Croat.EuropeanPortugueseandRussiantranslationsareinprocess.

SECTION2:SCALEDEFINITIONS

COMPASSIONSATISFACTION
Compassionsatisfactionisaboutthepleasureyouderivefrombeingabletodoyourworkwell.Forexample,
youmayfeellikeitisapleasuretohelpothersthroughyourwork.Youmayfeelpositivelyaboutyour
colleaguesoryourabilitytocontributetotheworksettingoreventhegreatergoodofsociety.

COMPASSIONFATIGUE
Professionalqualityoflifeincorporatestwoaspects,thepositive(CompassionSatisfaction)andthenegative
(CompassionFatigue).Compassionfatiguebreaksintotwoparts.Thefirstpartconcernsthingssuchassuchas
exhaustion,frustration,angeranddepressiontypicalofburnout.SecondaryTraumaticStressisanegative
feelingdrivenbyfearandworkrelatedtrauma.Itisimportanttorememberthatsometraumaatworkcanbe
direct(primary)trauma.Workrelatedtraumabeacombinationofbothprimaryandsecondarytrauma.

7
Kadambi,M.A.,&Ennis,L.(2004).Reconsideringvicarioustrauma:Areviewoftheliteratureandits'limitations.JournalofTrauma
Practice,3(2),121.
8
Arvay,M.J.(2001).Secondarytraumaticstressamongtraumacounsellors:Whatdoestheresearchsay?InternationalJournalforthe
AdvancementofCounselling,23(4),283293.
9
Figley,C.R(Ed.).(1995)Compassionfatigue:Copingwithsecondarytraumaticstressdisorderinthosewhotreatthetraumatized.New
York:Brunner/Mazel.
10
Figley,C.R.,&Stamm,B.H.(1996).PsychometricReviewofCompassionFatigueSelfTest.InB.H.Stamm(Ed),MeasurementofStress,
TraumaandAdaptation.Lutherville,MD:SidranPress.
11
Stamm,B.H.(2002).MeasuringCompassionSatisfactionasWellasFatigue:DevelopmentalHistoryoftheCompassionFatigueand
SatisfactionTest.InC.R.Figley(Ed.),107119.
12 nd
Stamm,B.H.(2008).TheProQOLTestManual,2 Ed.Towson,MD:SidranPressandtheProQOL.org.
13
Bride,B.E.,Robinson,M.M.,Yegidis,B.L.,&Figley,C.R.(2004).Developmentandvalidationofthesecondarytraumaticstressscale.
ResearchonSocialWorkPractice,14(1),2735.

12

BURNOUT
BurnoutisoneelementofthenegativeeffectsofcaringthatisknownasCompassionFatigue.Mostpeople
haveanintuitiveideaofwhatburnoutis.Fromtheresearchperspective,burnoutisassociatedwithfeelingsof
hopelessnessanddifficultiesindealingwithworkorindoingyourjobeffectively.Thesenegativefeelings
usuallyhaveagradualonset.Theycanreflectthefeelingthatyoureffortsmakenodifference,ortheycanbe
associatedwithaveryhighworkloadoranonsupportiveworkenvironment.

SECONDARYTRAUMATICSTRESS
SecondaryTraumaticStress(STS)isanelementofCompassionfatigue(CF).STSisaboutworkrelated,
secondaryexposuretopeoplewhohaveexperiencedextremelyortraumaticallystressfulevents.Thenegative
effectsofSTSmayincludefearsleepdifficulties,intrusiveimages,oravoidingremindersofthepersons
traumaticexperiences.STSisrelatedtoVicariousTraumaasitsharesmanysimilarcharacteristics.

SECTION3:SCALEPROPERTIES

SCALEDISTRIBUTION

TABLE1:PROQOLMOMENTS
CStscore BOtscore STStscore
N 1187 1187 1187
Mean 50 50 50
Std.ErrorofMean 0.29 0.29 0.29
Median 51 49 49
Mode 53 51 49
Std.Deviation 10 10 10
Skewness 0.92 0.25 0.82
Kurtosis 1.51 0.31 0.87

RELIABILITY

VALIDITY

Thereisgoodconstructvaliditywithover200publishedpapers.Therearealsomorethan100,000articleson
theinternet.Ofthe100publishedresearchpapersoncompassionfatigue,secondarytraumaticstressand
vicarioustraumatization,nearlyhalfhaveutilizedtheProQOLoroneofitsearlierversions.Thethreescales
measureseparateconstructs.TheCompassionFatiguescaleisdistinct.Theinterscalecorrelationsshow2%
sharedvariance(r=.23;co=5%;n=1187)withSecondaryTraumaticStressand5%sharedvariance(r=..14;
co=2%;n=1187)withBurnout.WhilethereissharedvariancebetweenBurnoutandSecondaryTraumatic
Stressthetwoscalesmeasuredifferentconstructswiththesharedvariancelikelyreflectingthedistressthatis
commontobothconditions.Thesharedvariancebetweenthesetwoscalesis34%(r=.58;;co=34%;

13

n=1187).Thescalesbothmeasurenegativeaffectbutareclearlydifferent;theBOscaledoesnotaddressfear
whiletheSTSscaledoes.

SECTION4:ADMINISTRATIONOFTHEPROQOL

PerhapsthemostimportantpartofadministrationoftheProQOL,orforthatmatteranypsychologicaltest,is
forpeopletounderstandwhattheyarebeingaskedtodo.Iftheyfeelliketheyarebeingobservedand
measuredfortheir(bad)behavior,theyareunlikelytowanttoparticipateor,iftheydo,toprovidereliable
answers.Itisimportanttoexplainthelogicofthemeasureandtoengagethepersonsdesiretotakethetest.
Itisalsoimportanttoestablishifthepersonhasarighttorefusetotakethetestorifitisrequiredasa
conditionofsomesituationsuchasemployment.

INDIVIDUALADMINISTRATION

Inthistypeofadministration,apersontypicallytakesthetestandeitherselfscoresorreceivesscores
computedbyacomputer.Inthissituation,thedataarenotrecordedelsewhereandthepersondoesnot
discusshisorherresultsunlesstheychoosetodoso.Individualadministrationmayalsobeinitiatedbyan
outsidesource.Thedatamayormaynotbearchived.Forexample,apersonmaytaketheProQOLaspartof
jobcounselingoranemployeeassistanceprogram.TheymaytaketheProQOLaspartoftheirongoingself
careplan.Itisimportanttoestablishwiththeindividualexactlywhatwillhappenwithhisorherdatabecause
datasecurityandprivacyareveryimportantissues.Inmanycases,therequiredstandardsexceedthoseof
generalmedicalrecords.

14

TABLE7:YEARSINFIELD
CStscore BOtscore STStscore
<5years 5to15 >15 <5years 5to15 >15 <5years 5to15 >15
years years years years years years
Mean 49.52 49.80 50.36 47.44 48.59 47.36 48.35 47.42 47.85
Std.Dev 10.41 9.38 9.47 9.16 8.14 9.59 8.83 8.80 9.89
N 183 136 165 183 136 165 183 136 165

Nostatisticaldifferenceswereobservedacrossyearsinfieldgroups.

INTERPRETINGINDIVIDUALSCALES

COMPASSIONSATISFACTION

Compassionsatisfactionischaracterizedbyfeelingsatisfiedbyonesjobandfromthehelpingitself.Itis
characterizedbypeoplefeelinginvigoratedbyworkthattheyliketodo.Theyfeeltheycankeepupwithnew
technologyandprotocols.Theyexperiencehappythoughts,feelsuccessful,arehappywiththeworktheydo,
wanttocontinuetodoit,andbelievetheycanmakeadifference.

COMPASSIONFATIGUE

Compassionfatigueischaracterizedbythenegativeaspectsofprovidingcaretothosewhohaveexperienced
extremeortraumaticstressors.Thesenegativeresponsesincludefeelingsofbeingoverwhelmedbythework
thataredistinguishedfromfeelingsoffearassociatedwiththework.Thus,therearetwoscalesfor
CompassionFatigue.

BURNOUT

BurnoutisthepartofCompassionFatiguethatischaracterizedbyfeelingsofunhappiness,disconnectedness,
andinsensitivitytotheworkenvironment.Itcanincludeexhaustion,feelingsofbeingoverwhelmed,bogged
down,beingoutoftouchwiththepersonheorshewantstobe,whilehavingnosustainingbeliefs.

SECONDARYTRAUMATICSTRESS

SecondaryTraumaticStressisanelementofcompassionfatiguethatischaracterizedbybeingpreoccupied
withthoughtsofpeopleonehashelped.Caregiversreportfeelingtrapped,onedge,exhausted,overwhelmed,
andinfectedbyotherstrauma.Characteristicsincludeaninabilitytosleep,sometimesforgettingimportant
things,andaninabilitytoseparateonesprivatelifeandhisorherlifeasahelperandexperiencingthe
traumaofsomeoneonehelped,eventotheextentofavoidingactivitiestoavoidremindersofthetrauma.It
isimportanttonotethatdevelopingproblemswithsecondarytraumaticstressisrarebutitdoeshappento
manypeople.

21

INTERPRETINGSCALESCORESINCOMBINATION

HIGHCOMPASSIONSATISFACTION,MODERATETOLOWBURNOUTANDSECONDARY
TRAUMATICSTRESS

Thisisthemostpositiveresult.Thisresultrepresentsapersonwhoreceivespositivereinforcementfromtheir
work.Theycarrynosignificantconcernsaboutbeingboggeddownorinabilitytobeefficaciousintheir
workeitherasanindividualorwithintheirorganization.Theydonotsufferanynoteworthyfearsresulting
fromtheirwork.Thesepersonsmaybenefitfromengagement,opportunitiesforcontinuingeducation,and
otheropportunitiestogrowintheirposition.Theyarelikelygoodinfluencesontheircolleaguesandtheir
organization.Theyareprobablylikedbytheirpatients,whoseekouttheirassistance.

HIGHBURNOUT,MODERATETOLOWCOMPASSIONSATISFACTIONANDSECONDARY
TRAUMATICSTRESS

Peoplewhoscorehighonburnout,inanycombinationwiththeotherscales,areatriskasindividualsandmay
alsoputtheirorganizationsinhighrisksituations.Burnoutisafeelingofinefficacy.Intheworksetting,this
maybearesultofpersonalororganizationalfactors.Theprototypeburnoutisassociatedwithhighworkloads
andpoorsystemfunction.Apersonmayfeelasifthereisnothingtheycandotomakethingsbetter.Itis
likelytheyaredisengagedfromtheirpatients,eventhoughthisisnotassociatedwithanyfearasaresultof
engagementwiththeirpatients.Peoplesufferingfromburnoutoftenbenefitfromtakingtimeoff.Theymay
alsobenefitfromchangingtheirroutinewithintheorganization.Organizationsthathavemanypeoplewith
burnoutshouldseriouslyconsidertheirorganizationalsystemandtheuseoftheirhumancapitaltoidentify
pitfallsinthesystemandwaystosupportpeopleinaccomplishingbusinessgoalsandwork.

HIGHSECONDARYTRAUMATICSTRESSWITHLOWBURNOUTANDLOWCOMPASSION
SATISFACTION

Peoplewhomakethesescoresaretypicallyoverwhelmedbyanegativeexperienceatworkascharacterized
byfear.Ifthisfearisrelatedtoaneventthathappenedtothepersondirectly,suchashavingtheirlife
endangeredasaresultofparticipatinginadangerousrescue,oriftheyexperiencedatraumaticeventsuchas
sexualviolencebyacolleague,thesearenotsecondaryexperiences.Thesearedirectexposurestodangerous
events.However,ifthepersonsfearisrelatedtotakingcareofotherswhoweredirectlyinharmsway,thisis
secondarytraumaticstress.Thesepeoplearelikelytobenefitfromimmediatetreatmentfortraumaticstress
and,whenpresent,depression.Becausetheyareneutralinregardtotheirfeelingsofinefficacyatwork,or
feelingsofpleasureassociatedwiththeirwork,considerfocusingonthefearrelatedworkexperiences.
Counteringthefearmightincludechangingthecaseloadmix,theworkenvironment(likeassigningworkwith
colleagueswhomtheytrust),orintroducingothersafetymeasures.

22

HIGHSECONDARYTRAUMATICSTRESSANDHIGHCOMPASSIONSATISFACTIONWITH
LOWBURNOUT

Thiscombinationistypicallyuniquetohighrisksituationssuchasworkinginareasofwarandcivilviolence.
Peoplewhoscoreinthisrangeareoftenhighlyeffectiveattheirworkbecausetheyfeeltheirworkmatters.
However,theyhaveaprivateselfthatisextremelyfearfulbecauseoftheirengagementwithothers.Some
fearisaccurateandappropriateinhighrisksituation.However,highsecondarytraumaticstressismarkedby
thoughts,feelings,andmemoriesofotherstraumaticexperiencesmixedwiththeirownexperiences.Thiscan
beparticularlydifficulttounderstandwhentheexperiencesofthosetowhomthepersonprovideshelpare
similartohisorherown.Knowingthatothershavebeentraumatizedbythesametypeofsituationsinwhich
thepersonfindshimorherselfhasthepotentialtochangethepersonsinterpretationoftheevent.

Peoplewithscoreslikethistypicallybenefitfromencouragementtobuildontheirfeelingsofaltruismand
thoughtsthattheyarecontributingtothegreatergood.Simultaneously,theirfearsandfearrelated
symptomsshouldbeaddressed.Depressionistheoreticallyunlikelygiventheirhighfeelingsofsatisfaction.At
times,changesintheworkenvironmentcoupledwithadditionalsupportivesupervisionmayalleviatethe
PTSDlikesymptoms.Atothertimes,therapyormedicationorbothmaybeagoodalternative.

HIGHSECONDARYTRAUMATICSTRESSANDHIGHBURNOUTWITHLOWCOMPASSION
SATISFACTION

Thiscombinationisseeminglythemostdistressing.Notonlydoesthepersonfeeloverwhelmedanduselessin
theworksetting,theyareliterallyfrightenedbyit.Peoplewiththiscombinationofscoresareprobablyhelped
mostbybeingremovedfromtheircurrentworksetting.AssessmentforPTSDanddepressionisimportant.
Treatmentforeitherorbothmayhavepositiveoutcomes,butareturntoanunmodifiedworksituationis
unlikelytobefruitful.However,ifthepersoniswilling,itmaybethatheorshecanchangetheefficacyby
addressingtheirownskillsandsystems(suchasadditionaltraining)orbyworkingwiththeorganizationto
identifyareorganizedworkassignment.

INTERPRETINGTHEPROQOLATAGROUPLEVEL

Yearsofdatacollectionandpracticebasedevidencehaveprovidedusefulinformationonsystemand
individuallevels.Forexample,thereappeartobenoscalescoredifferencesbygender.Nonehavebeen
observedbycountry,althoughthismaybereflectiveofthetypeofworkersandsettingsthatareusing
westernizedmeasures.Whilenotshownintheoveralldatabank,someunpublishedstudiesaswellassome
individualstudiesthatcontributedtothebankshoweddifferencesbasedonthenumberofyearsinthefield
moreyearsinthefieldtypicallyisassociatedwithlowerscores.Whileitistemptingtopresumethosewith
moreexperiencedobetter,itislikelythatthosewithgreaterexposureandlowresiliencyleftthefield,while
thosethatremainedweredifferentiallyresilient.Whenlookingacrossprofessions,suchasmentalhealth,
physicalhealth,andchildprotectionworkers,dataindicatesthatphysicalhealthworkers(e.g.,nurses,primary
caredoctors)experiencetheleasttrauma,whileteachersremainthemostsatisfied.Ascouldbeexpected,
thoseworkersdealingwithchildrenandfamiliesintraumatendtoexperiencehigherlevelsofBOthanany
othergroup.

23

SECTION7:USINGTHEPROQOLFORDECISIONMAKING

Obviously,theidealworkenvironmentintermsofmanagingstressandtraumaisonethatcombineshighCS
withlowBOandSTS.Practicebasedevidenceandpreliminaryquantitativeevidencesuggestinteresting
resultsinlessthanidealworkenvironments.ThosewhohavehighlevelsofSTSaccompaniedbyhighCSand,
typically,astrongsenseofaltruism,maycontinuetobeeffectiveattheirjobsandoftenrespondwelltoa
shortSTSintervention.Whileitisimportantforaworkerssupervisortomakethistypeofdecision
individually,sometimesitispossibletoaccomplishinterventioninvivo,withoutchangingaworkassignment.
Incontrast,thosewithhighlevelsofbothBOandSTSmaybethemostatrisk,bothtothemselvesandina
worksetting.Inthissituation,thecaregiversareafraidandseenohopeforchange,whichpotentiallyruins
theireffectiveness.Theoretically,thisnegativeprofileisassociatedwithmedicalerror,butbecausethedata
arenotinonthatconcern,itistoosoontosaywithcertainty.Regardlessofthesystemeffectsofpeoplewho
areexperiencinghighlevelsofbothBOandSTS,itisimportantthatinterventionsbepursuedforthemas
individuals.Supervisorsshouldconsiderjobreassignmentduringtheinterventiontime.

CHANGINGTHEPERSONEVENTINTERACTION

OneoftherewardingaspectsoftheProQOListhatitprovidesaplatformforchange.Itcanleadto
introspectionandtobrainstormingaboutwhatisrightandwhatcanbemadebetterandwhatiswrongand
cannotbemadebetter.Itisimportanttoidentifythingsthataregoingwellandthosethingsthatarenot.Itis
alsoimportanttorealizethatsomethingsshouldbehorrible.Dealingwithburnvictims,forexample,cannot
reallybenormalized.Theburnsthemselvesareseriouswoundsandnooneshouldtrytopretendotherwise.
However,thatsameburnvictimmayprovideagoodsourceofcompassionsatisfactionwhenthehelperfeels
thatadifferenceisbeingmade.Indangeroussettings,itiscriticallyimportantnottotrytotakeawaypeoples
necessaryfears.Beingafraidmaybetheverythingthatkeepsthemfrombeingkilled.

Attheindividuallevel,apersonmayreviewpersonalandworkenvironments.Thismaybedoneindividually,
withfamily,withafriendorcolleague,orwithaprofessional.Regardlessofthemethod,thisisaplanabout
thatpersonandforthatperson;itishisorhersandnottheiremployersortheirdoctors.Aplandictated
fromoutsideislikelytoleadtodissatisfactionandamarkerforburnoutanorganizationthatdictates
personalbeliefsisprobablyanorganizationthatdoesnotvaluetheirpersonnelsthoughtsandfeelings.

Changingworkgroupscanbeeasyoritcanbeverydifficult.Thedifferenceistheinterestofthegroupin
investigatingandrespondingtoissuesofprofessionalqualityoflife.Someworkgroupsjustdonotwantto
dealwiththeissue.Theremaybeanattitudeofifyoucannottaketheheat,getoutofthekitchen.Other
groupsmaygenuinelywanttochangebutmaynotknowhowbesttochange.Somegroupsbecomedistressed
thatchangeisnotpossiblewithoutanoutsidesource.Somegroupsmayalreadybefunctioningwellandno
changeisadvisable.Theroleofthehelperinthissituationistotrytohelpthegroupmembersidentifytheir
styleandworkfromthere.Theprinciplesofanygoodgrouptheorycanassistinmanagingagroupsneeds.
Itisimportanttorememberthattherewillbetimeswhenagroupsneedsareveryclearandquite
reasonable,butunattainable.Thisiscommonincivilviolenceorwarsettings.Aworkgroupsmembersmay
decidethattheywishtochangeshiftsmoreoften.However,theremaybeinsufficientnumbersofpeopleto
makethatpossible.Insituationssuchasthis,yourroleistotrytoidentifyalternativestothereallyneeded,
butimpossible,intervention.Thegroupmembersthemselvesmaybethebestsourceofalternatives.

24

MONITORINGCHANGEACROSSTIME

TheProQOLitselfisstableacrosstime,whichmeansthatthescoresacrosstimereflectchangesintheperson,
notinthemeasureitself.SomepeopleselfadministertheProQOLataregularselfdeterminedintervaltosee
howtheyaredoing.Othersmaychoosetotakethetestonce.Someorganizationswillrequiremultiple
administrationswhileothersmayignoreprofessionalqualityoflifealtogether.

IftheProQOLisusedacrosstime,thereshouldbeawaytoconsiderwhatthosechangesmean.Thiscanbe
somethingassimpleasagraphshowingapersonsupsanddownsacrosstimeoritmaybeaformalreviewof
onesselfcareplanortheplanforaworkgroup.Itisimportantthattheinformationbeuseful.Onepotentially
importantuseoftheinformationistoreevaluateandadjustonesselfcareplanorevenagroupsor
organizationsplan.

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YOUR SCORES ON THE PROQOL: PROFESSIONAL QUALITY OF LIFE

SCREENING

Based on your responses, place your personal scores below. If you have any concerns, you should discuss
them with a physical or mental health care professional.
Compassion Satisfaction _____________
Compassion satisfaction is about the pleasure you derive from being able to do your work well. For example,
you may feel like it is a pleasure to help others through your work. You may feel positively about your
colleagues or your ability to contribute to the work setting or even the greater good of society. Higher scores
on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job.
The average score is 50 (SD 10; alpha scale reliability .88). About 25% of people score higher than 57 and
about 25% of people score below 43. If you are in the higher range, you probably derive a good deal of
professional satisfaction from your position. If your scores are below 40, you may either find problems with
your job, or there may be some other reasonfor example, you might derive your satisfaction from activities
other than your job.

Burnout_____________
Most people have an intuitive idea of what burnout is. From the research perspective, burnout is one of the
elements of Compassion Fatigue (CF). It is associated with feelings of hopelessness and difficulties in dealing
with work or in doing your job effectively. These negative feelings usually have a gradual onset. They can
reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or
a non-supportive work environment. Higher scores on this scale mean that you are at higher risk for burnout.
The average score on the burnout scale is 50 (SD 10; alpha scale reliability .75). About 25% of people score
above 57 and about 25% of people score below 43. If your score is below 18, this probably reflects positive
feelings about your ability to be effective in your work. If you score above 57 you may wish to think about
what at work makes you feel like you are not effective in your position. Your score may reflect your mood;
perhaps you were having a bad day or are in need of some time off. If the high score persists or if it is
reflective of other worries, it may be a cause for concern.

Secondary Traumatic Stress_____________

The second component of Compassion Fatigue (CF) is secondary traumatic stress (STS). It is about your work
related, secondary exposure to extremely or traumatically stressful events. Developing problems due to
exposure to others trauma is somewhat rare but does happen to many people who care for those who have
experienced extremely or traumatically stressful events. For example, you may repeatedly hear stories about
the traumatic things that happen to other people, commonly called Vicarious Traumatization. If your work
puts you directly in the path of danger, for example, field work in a war or area of civil violence, this is not
secondary exposure; your exposure is primary. However, if you are exposed to others traumatic events as a
result of your work, for example, as a therapist or an emergency worker, this is secondary exposure. The
symptoms of STS are usually rapid in onset and associated with a particular event. They may include being
afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things
that remind you of the event.
The average score on this scale is 50 (SD 10; alpha scale reliability .81). About 25% of people score below 43
and about 25% of people score above 57. If your score is above 57, you may want to take some time to think
about what at work may be frightening to you or if there is some other reason for the elevated score. While
higher scores do not mean that you do have a problem, they are an indication that you may want to examine
how you feel about your work and your work environment. You may wish to discuss this with your
supervisor, a colleague, or a health care professional.

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WHAT IS MY SCORE AND WHAT DOES IT MEAN?

In this section, you will score your test and then you can compare your score to the interpretation below.
To find your score on each section, total the questions listed on the left in each section and then find your
score in the table on the right of the section.

Compassion Satisfaction Scale:

3. ____
6. ____ The sum of my So My Score My Level of
Compassion Equals Compassion
12. ____
Satisfaction questions
16. ____
22 or less 43 or less Low
18. ____
20. ____ Between 23 and 41 Around 50 Average

22. ____ 42 or more 57 or more High

24. ____
27. ____
30. ____
T o t a l : _____

Burnout Scale:
*1. ____ = ____
*4. ____ = ____ The sum of my So My Score My Level of
Burnout Questions Equals Burnout
8. ____
10. ____ 22 or less 43 or less Low
*15. ____ = ____ Between 23 and 41 Around 50 Average
*17. ____ = ____
42 or more 57 or more High
19. ____
21. ____
26. ____
*29. ____ = ____
Reverse the scores for those that are starred.

0=0, 1=5, 2=4, 3=3, 4=2, 5=1

T o t a l : _____

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Secondary Trauma Scale:

2. ____
5. ____ The sum of my So My Score My Level of
Secondary Traumatic Equals Secondary
7. ____
Stress questions Traumatic
9. ____ Stress
11. ____
22 or less 43 or less Low
13. ____
Between 23 and 41 Around 50 Average
14. ____
23. ____ 42 or more 57 or more High
25. ____
28. ____
T o t a l : _____

30