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Compassion Fatigue

In the U.S., one in five adults cares for an aging, terminally or chronically ill loved one. Caring for another can be a difficult responsibility. While many rewards come with caregiving, there are sacrifices, and demands may be high. Many caregivers try to be all and do all for their loved one at the expense of their own health. Caring too much can hurt! Those involved in a caregiving ministry, such as those who participate in a Caregiving Team, can be especially vulnerable. When Team members focus on others without practicing authentic, ongoing selfcare, destructive behaviors can surface. These harmful behaviors and attitudes are associated with a phenomenon called compassion fatigue. Compassion stems from caring and recognizing anothers suffering. It involves: Recognizing our own pain Feeling concern for the person in need Identifying with the pain of their losses Becoming a companion, accompanying the suffering person into their pain While compassion is an asset in Caregiving Team ministry, it can also negatively affect team members and care partners when self-care is not given priority. It affects those in the health care and mental health professions, as well as those who serve within the home as caregivers. It can cause harm to both individual team members and the ministry of the Team. What is Compassion Fatigue? Compassion fatigue has replaced the more familiar term burn-out. Burn out can be defined as a state of extreme dissatisfaction with ones work. Compassion fatigue is not dissatisfaction with being compassionate or caring. It is, more accurately, a physical, emotional, and spiritual fatigue or exhaustion that takes over a person and can create acute emotional pain for them. This state of tension can cause a decline in her or his ability to experience joy or to feel and care for others. This fatigue is a result of a one-way street of giving care, in which individuals are investing a great deal of energy and compassion in others over a period of time, yet arent able to get enough in return to reassure them that the world is a hopeful place. Its this constant expression of compassion and caring for others not being balanced by strong compassion and caring for self, over time, which can lead to bleak feelings. Compassion fatigue symptoms are normal displays of stress resulting from the too intensive caregiving being done on a regular basis.

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Symptoms of compassion fatigue include: Fatigue Increase in illness Gastrointestinal complaints Changes in thinking, being, critical and cynical Excessive blaming of others Difficulty making decisions, not seeing options Diminished sense of personal accomplishment Difficult concentrating Denial about problems Depression Emotional distancing from loved ones Reduced ability to care for others Increased irritability, anger, hostility Overreacting to situations Humor filled with sarcasm High self-expectations Abusing alcohol or drugs

What causes Compassion Fatigue? Compassion fatigue can arise from a variety of sources. Usually it will arise in people who are in a situation or setting where they are caregivers and expending emotional and physical energy day in and day out. This includes Team members. Compassion fatigue on a Caregiving Team level may include the following symptoms: High absenteeism Frequent tardiness Lack of flexibility among members Less willing to comply with guidelines At a minimum, these symptoms can create periodic disharmony among team members, team leaders, and those in pastoral care. When the symptoms are more pronounced, it can lead to a gradual, painful, erosion of the Teams ministry. Time, or a lack of it, is the enemy to those in the grip of compassion fatigue. They allot more time to caregiving duties and reduce the time spent on those very activities which would help alleviate symptoms and revitalize their energy and spirits: regular exercise, time with friends, interests aside from caregiving, relaxed meals, prayer, and meditation. This is especially true for those who are caring for a loved one or family member. Decaying team member relationships Strong reluctance to change Cannot see ways to improve

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

Compassion fatigue is a process. It is not something that will arise in one day. It will happen gradually, taking weeks or sometimes years to arise. Over time, the ability to feel and care for others can become eroded through overuse of the caregivers gift of compassion. The effects of compassion fatigue can be dismal, yet the chances for a complete recovery are not. There is hope for those who may be in the midst of compassion fatigue. People who sense they are suffering from compassion fatigue probably are. The truth is, the presence of compassion fatigue actually validates the fact that those who are experiencing the symptoms are, in fact, deeply caring individuals. This awareness and breaking through the bonds of denial begin the process of healing. How to heal from Compassion Fatigue? Awareness of the symptoms of compassion fatigue, and their negative affect on ones life, can lead to positive change, personal transformation, and a new resiliency. Denial is one of the most detrimental symptoms of compassion fatigue. It can hinder the ability to assess ones own level of fatigue and stress, thereby thwarting the healing process. Team members would do well to occasionally take inventory of themselves as a team process to check for the presence of this fatigue. We have an educational module on taking a team inventory that may help identify areas worthy of improvement. There are several self-tests designed to help individual caregivers recognize their symptoms of compassion fatigue. Most can be found by doing an internet search on compassion fatigue. One of the most widely used is the Compassion Satisfaction and Fatigue (CSF) Test. It is attached as a handout here, with a scoring tool, and can also be downloaded at: http://www.isu.edu/~bhstamm/tests.htm When Team members know their lives are affected by compassion fatigue, they need to remember to focus care for themselves. The warning from all flight attendants to put your own oxygen mask on before you put the oxygen mask on your child or a frail adult holds true in care giving. Before caregivers can tend to and be sensitive to the needs of others, it is important that they first take care of their own well-being. As a Caregiving Team, this is where regular team meetings provide a big benefit. Regular Team meetings allow team members the opportunity to talk about their struggles, and ask for help to meet the needs of care partners. They also provide a format for education about caregiving, division of labor on a Caregiving Team, and also valuable fellowship among members.

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

Caregivers must continually commit to authentic self-care, even while engaging in the care of another. To prevent and recover from this fatigue, caregivers need to take time for self reflection, identify whats important, and live in a way that reflects it. That is easy to say, but not quite so simple to do. It can take discipline to learn to care for ones self while caring for another. Some ways to enhance a commitment to self are: Be kind to yourself. It is okay to make mistakes! Enhance your awareness with education about compassion fatigue. Learn to accept your own learning process as an ongoing process. Develop a healthy support system of people, a Caregiving Team, for example, who contribute to your self esteem, who listen well and who care. Have one focused, connected and meaningful conversation each day. Other ways to enhance a commitment to self are: Listen to others who are suffering as well, but maintain healthy personal boundaries. Understand that previous avenues of support may not be there in your journey now. Practicing the art of self management and learn to say no. Choose your battles. Reserve your energy for worthy causes. Learn to express your own needs. Try to spend some quiet time alone. Engage in health building activities such as exercise, yoga, meditation, or massage. Eating healthy foods and drinking plenty of water. Organize your life to become proactive to situations rather than reactive to crises.

Preventing compassion fatigue is really the key. Caregivers must continually practice good emotional health maintenance in their journey and maintain some sort of balance in life. Try doing something every day that will replenish you. Keep a portion of life where you can receive, rather than give. This will be different for each individual, which may be getting a massage or spending time doing something truly enjoyable. Stay aware of the positives in caregiving, and create more positives. None of these actions or changes will guarantee prevention; however, they will help create behaviors which will help the healing occur. If a Team member is unable to see the positives in their caregiving role, or if they do not seem to be able to take the time for self-care, referral to a professional counselor is recommended. With professional help, the caregiver can begin to gain perspective on their role and what they can do for themselves. Only with this perspective can they begin to regain a healthy role with caregiving. Remember, it is possible to practice healthy, ongoing self-care while successfully continuing to care for others.

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

Related Modules: Excellence in Caregiving How Well Are We Doing? Introspection Setting Boundaries Value of a Caregiving Covenant

Written by Chuck Fleming

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

ProQOL R-IV
PROFESSIONAL QUALITY OF LIFE SCALE Compassion Satisfaction and Fatigue SubscalesRevision IV Helping people puts you in direct contact with their lives. As you probably have experienced, your compassion for those you help has both positive and negative aspects. We would like to ask you questions about your experiences, both positive and negative, as a helper. Consider each of the following questions about you and your current situation. Select the number that honestly reflects how frequently you experienced these characteristics in the last 30 days. 0=Never 1=Rarely 2=A Few Times 3=Somewhat Often 4=Often 5=Very Often

1. I am happy. 2. I am preoccupied with more than one person I help. 3. I get satisfaction from being able to help people. 4. I feel connected to others. 5. I jump or am startled by unexpected sounds. 6. I feel invigorated after working with those I help. 7. I find it difficult to separate my personal life from my life as a helper. 8. I am losing sleep over traumatic experiences of a person I help. 9. I think that I might have been infected by the traumatic stress of those I help. 10. I feel trapped by my work as a helper. 11. Because of my helping, I have felt on edge about various things. 12. I like my work as a helper. 13. I feel depressed as a result of my work as a helper. 14. I feel as though I am experiencing the trauma of someone I have helped. 15. I have beliefs that sustain me. 16. I am pleased with how I am able to keep up with helping techniques and protocols. 17. I am the person I always wanted to be. 18. My work makes me feel satisfied. 19. Because of my work as a helper, I feel exhausted. 20. I have happy thoughts and feelings about those I help and how I could help them. 21. I feel overwhelmed by the amount of work or the size of my caseload I have to deal with. 22. I believe I can make a difference through my work.

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

23. I avoid certain activities or situations because they remind me of frightening experiences of the people I help. 24. I am proud of what I can do to help. 25. As a result of my helping, I have intrusive, frightening thoughts. 26. I feel bogged down by the system. 27. I have thoughts that I am a success as a helper. 28. I can't recall important parts of my work with trauma victims. 29. I am a very sensitive person. 30. I am happy that I chose to do this work. Copyright Information
B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV (ProQOL). http://www.isu.edu/~bhstamm. This test may be freely copied as long as (a) author is credited, (b) no changes are made other than those authorized below, and (c) it is not sold. You may substitute the appropriate target group for [helper] if that is not the best term. For example, if you are working with teachers, replace [helper] with teacher. Word changes may be made to any word in italicized square brackets to make the measure read more smoothly for a particular target group.

Disclaimer This information is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a health problem without consulting a qualified health or mental health care provider. If you have concerns, contact your health care provider, mental health professional, or your community health center. Self-scoring directions, if used as self-test 1. Be certain you respond to all items. 2. On some items the scores need to be REVERSED. Next to your response write the reverse of that score (i.e. 0=0, 1=5, 2=4, 3=3). Reverse the scores on these 5 items: 1, 4, 15, 17 and29. Please note that the value 0 is not reversed, as its value is always null. 3. Mark the items for scoring: a. Put an X by the 10 items that form the Compassion Satisfaction Scale: 3, 6, 12, 16, 18, 20, 22, 24, 27, 30. b. Put a check by the 10 items on the Burnout Scale: 1, 4, 8, 10, 15, 17, 19, 21, 26, 29. c. Circle the 10 items on the Trauma/Compassion Fatigue Scale: 2, 5, 7, 9, 11, 13, 14, 23, 25, 28.

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

4. Add the numbers you wrote next to the items for each set of items and compare with the theoretical scores.
B. Hudnall Stamm, 1997-2008. Professional Quality of Life: Compassion Satisfaction and Fatigue Scales, R-IV (ProQOL). http://www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold.

701 N. Post Oak Rd., Ste. 330, Houston, TX 77024 | 713-682-5995 info@interfaithcarepartners.org | www.interfaithcarepartners.org

CAREGIVING TEAM Your Scores On The ProQOL: Professional Quality of Life Screening
For more information on the ProQOL, go to http://www.proqol.org

Based on your responses, your personal scores are 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 37 (SD 7; alpha scale reliability .87). About 25% of people score higher than 42 and about 25% of people score below 33. If you are in the higher range, you probably derive a good deal of professional satisfaction from your position. If your scores are below 33, 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 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 22 (SD 6.0; alpha scale reliability .72). About 25% of people score above 27 and about 25% of people score below 18. If your score is below 18, this probably reflects positive feelings about your ability to be effective in your work. If you score above 27 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. Compassion Fatigue/Secondary Trauma_____________

Compassion fatigue (CF), also called secondary trauma (STS) and related to Vicarious Trauma (VT), is about your work-related, secondary exposure to extremely stressful events. For example, you may repeatedly hear stories about the traumatic things that happen to other people, commonly called VT. If your work puts you directly in the path of danger, such as being a soldier or humanitarian aide worker, this is not secondary exposure; your exposure is primary. However, if you are exposed to others traumatic events as a result of your work, such as in an emergency room or working with child protective services, this is secondary exposure. The symptoms of CF/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 13 (SD 6; alpha scale reliability .80). About 25% of people score below 8 and about 25% of people score above 17. If your score is above 17, 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.
B. Hudnall Stamm, 1997-2008. Professional Quality of Life: Compassion Satisfaction and Fatigue Scales, R-IV (ProQOL). http://www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. This information is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a health problem without consulting a qualified health or mental health care provider. If you have concerns, contact your health care provider, mental health professional, or your community health center.