Ethical Considerations in Field with Compassion Fatigue and

Ethical Considerations in Field with Compassion Fatigue and

Ethical Considerations in Field with Compassion Fatigue and Trauma Jon Hudson, MSW, PhD University of Wisconsin, Oshkosh Department of Social Work 22nd of September 2016 Concerns over Secondary Traumatic Stress Among Social Workers Study of direct practice social workers in 2007 found that it was highly likely SW would be exposed to secondary trauma and experience symptoms of STS, while 15% developed PTSD STS and compassion fatigue are becoming increasingly viewed as an occupational hazard of

providing direct services to traumatized populations (Bride, 2007) Social workers who experience compassion fatigue and STS are believed be at higher risk to make poor professional judgments in comparison to those not demonstrating STS and compassion fatigue but there is not absolute scale used in the measurement of these two issues (Bride, Radey, & Figley, 2007) Not generally addressed to a high degree in most BSW programs and many MSW programs but there Primary Traumatic Response v. Secondary Traumatic Response A primary traumatic response is when the worker is exposed to the event

Secondary traumatic response is the proximity of the worker to the event, in most cases this is exposure to a traumatic event through contact with the client (Badger, 2001) Critical Incident Stress The psychological consequence of a critical event that is perceived by the individual as being outside the normal range of his/her daily experience and the results of which can be psychological, physical, and emotional distress (Beaton, 2003) Vicarious Trauma or Traumatization Taken from constructivist selfdevelopmental theory Changes to the therapist cognitive beliefs

related to self, other, and the world are cumulative and permanent VT is associated with disruptions to either ones: Safety Trust Esteem Intimacy Control (Pearlman & Saakvitne, 1995) Vicarious Trauma or Traumatization Factors contributing to VT taken from a

research synthesis 1994-2003 Personal history of trauma (persuasive) Amount of exposure to traumatic material of clients (hours with client, % of caseload, cumulative exposure (some) while NOT contributing (reasonable) Perceived coping ability as a protective factor (reasonable) Having supervision (some) Kracen, 2006) (Baird & Secondary Trauma or Secondary Traumatic Stress Associated with those (either professional, caregivers, family members) who experience symptoms, which are brought on by helping

persons suffering from PTSD The precipitating experience(s) of the individual can be of short duration such as with an EMS team Has been referenced and is similar to compassion fatigue by some A disorder that is characterized by: Exhaustion Hypervigilance Avoidance Numbing

Secondary Trauma or Secondary Traumatic Stress Factors contributing to ST taken from a research synthesis 1994-2003 Personal history of trauma (reasonable) but also NOT linked (reasonable) Amount of exposure to traumatic material of clients (hours with client, % of caseload, cumulative exposure (persuasive) while NOT contributing (some) Perceived coping ability as a protective factor (some) (Baird & Kracen, 2006)

Indirect Trauma Any indirect exposure to a traumatic event(s) can lead to the development of distressing and potentially enduring responses. Factors increasing risk include empathy and organizational stress. Most often occurs in the healthcare profession, but also with psychotherapists, shelter care staff, journalists, trauma researchers, and first responders, both paid and volunteer. Indirect trauma can sometimes occur when repeated viewing images of disastrous events Trauma Countertransference In response to the clients trauma, the social worker may start to assume the role

of rescuer or identifying with the trauma, causing boundary issues and/or attempts to control the client. The results of traumacountertransference include doubting or minimizing the clients denial, professional distancing, or in extreme cases, client abandonment (Herman, 1998) Compassion Fatigue A reduced capacity or interest in being empathetic and results from knowing about a traumatizing event experienced or suffered by a person or an ongoing crisis. A state of biological, psychological, and social exhaustion brought on by extended exposure to compassion stress and potentiated due to poor social support network both in the persons personal and professional lives.

Compassion fatigue can occur without experiencing secondary traumatic stress such as with mental illness (Newell & Nelson-Newell, 2014). Found to be related to both secondary Burnout The process of physical and emotional depletion resulting from conditions at work or, more consisely, prolonged job stress. (Osborn, 2004) Contributing factors Lack of supervision and support

Role conflict and role ambiguity Perceived unfairness in promotion (not applicable to students, but certainly to staff Limited worker autonomy Clients failure to improve (Ying, 2008) Risk Factors Being in human service work attributed to the emotional expectations involved and the high need for empathy , bureaucratic barriers, and balancing administrative work with other responsibilities (Newell & Nelson-Gardell, 2014) Personal distress, which is associated with primarily a self-focused and avoidant response aimed at relieving their own distress rather than the clients

High degree of personal stress (or a selffocused response) has been associated with a higher degree of compassion fatigue and burnout and lower compassion satisfaction (Thomas, 2013). Positive Factors Self-confidence and influence or effectiveness Internal locus of control High sense of self-esteem (Ying, 2008) High sense of competence in coping ability Maintaining an objective motivation v. a more

immediate motivation Resolution of personal traumas Drawing on positive role models of coping Buffering personal beliefs for providing positive coping abilities such as spirituality (Bell, 2003) Positive Factors Self-detachment a reflective, balanced, accurate assessment of reality Mindful self-awareness

Detachment from ones experiences that protect against over identification with subjective emotions and cognitions Recognition of ones own inadequacies, failures, and suffering as part of the universal human condition Self-kindness or forgiveness for ones inadequacies (Neff, 2003a, 2003b) High connections and support marked by a sense of positive regard (Saakvitne & Implications for Social Work Education and Field Service-learning and volunteering PRIOR to field

experience is consistent with lower risk for compassion fatigue and VT and use of group supervision for support and feedback (Collins, Coffey, & Morris, 2010) Use of strengths perspective in avoiding becoming too close to situations Encourage students to focus on their own experiences of trauma in relation to the process of healing and motivation for entering the social work field (Bell, 2003) Discuss the concepts of VT as a tool to assist students with anticipating and recognizing when/where this occurs and how to manage associated emotions, avoid stressing the pathological aftermath aspect of trauma (Courtois, 2002; Bussey, 2008)

Implications for Social Work Education and Field Screening students motivations for entering the field and the internship. Gatekeeping issues influencing appropriateness of being in the profession: low self-esteem, anxiety, self- doubt and stress increase the risk for compassion fatigue 2. Significantly higher incidence of sexual abuse in SW students compared to business students 3. Those with histories of trauma or mental health issues need to be screened for concerns with appropriateness 1. 2008) (Harr & Moore, 2011; Lafrance, Gray, & Herbert, 2004; Collins, Coffey & Morris, Implications for Social Work Education and Field

Addressing transference and countertransference. Often students have difficulty addressing both of these for fear of being viewed as incompetent, have unrealistic expectations, or simply lack self-awareness (Kanter, 2007). Managing and maintaining appropriate boundaries to prevent and diminish potential problems with STS, VT, and potentially PTSD. Communication with field instructors and field faculty related to concerns and problems, and observations indicating potential STS Implications for Social Work Education and Field Four key resiliency and protective factors (Saakvitne &

Pearlman, 1996) 1. Balance Developing mindfulness Developing skills related to non-reactivity Boundaries & Connections 2. Develop measures that help to disrupt memory formation post event- some form of distraction is best 3. Boundaries 4.

Emphasize that while you, the SW, have empathy and compassion for the person or persons involved in the traumatic event, your focus is to understand but not feel the clients pain. Self-Care Good supervision, both in field and in field seminar Recognition of STS situations and symptoms Self-soothing activities that foster self-protectiveness Implications for Social Work Education and Field Group Model approach involving 10, singlesession 2 hour groups that followed a format: Why are you here and what to expect (getting started)

Providing a context what is VT Recognizing and responding to VT how has it impacted you Ending and Transition lessons learned (Clemans, 2005)

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