Empathy_Fatigue

							Empathy Fatigue: Healing the
  Mind, Body, and Spirit of
  Professional Counselors

Mark A. Stebnicki, Ph.D., LPC, CRC, CCM
   Professor, Dept. of Rehab Studies
        East Carolina University
   The More We Stress Together…
 There are discrete, basic, and universal emotions that
  persons react to on a Mind, Body, & Spiritual level.
 Emotions involve different body systems which arouse
  our parasympathetic and sympathetic system.
 Chronic activation of the nervous system (stress
  response) has both a physiological and emotional cost.
 Cumulative effects of multiple client problems lead to a
  deterioration of the professional‟s coping skills and
  resiliency skills- esp. if symptoms go unrecognized.
 A Paradigm Shift in Mental Health and
    the Allied Helping Professions
 Horrific terrorist attack Sept. 11th (2,996 deaths)
 War in Afghanistan & Iraq (3,860 Am; 84K Iraqi
  Civilian deaths +)
 Tsunami December 26th 2004 (275,000 deaths+)
 Hurricane Katrina 2005 (70 deaths +)
 Child Deaths (intentional-unintentional) by gun
  violence (3,024 deaths/yr)
 School shooting deaths (171 deaths „92-‟98)
 Cumulative AIDS-related deaths in U.S (through 2002
  501,669d); Ethiopia (1.8 mil predicted by ‟08)
           Types of Disaster
   Fire                   Workplace violence
   Flood                  Traumatic injury in
   Hurricanes/Tornados     the workplace
   Ice storms             School shootings
   Plane crashes          Bioterrorism
   Volcanoes              Transportation
   Earthquakes             Accidents
   Epidemics              Civil Unrest
    Different Models & Philosophy in
             Crisis Response
 American Red Cross (ARC)

 Critical Incident Stress Debriefing (CISD)

 Critical Incident Stress Management (CISM)

 National Organization for Victim Assistance (NOVA)

 Acute Traumatic Stress Mgt (ATSM)

 NC Disaster Task Force (eclectic model)
       In a Constant State of Disaster
    Preparedness: Crisis Response Teams
   ARC                    Baptist Men
   EMS/IC-EM              Salvation Army
   Law/Fire               United Way
   Public Health          FEMA
   DSS                    National Guard/Military
   School Counselors      Insurance Adjustors
   CISM Teams             Media
   MH/LME                 Airline Industry
   EAPs                   Banks/Financial
                            Institutions
           Hurricane Katrina
 FW Katrinia Slide Show.ppt
       Who Takes Care of the
      Healer‟s Wounded Soul?
   “What kind of God could allow such pain,
   suffering, or horrific acts to take place …”

The search for personal meaning in extraordinary
   stressful and traumatic events due to natural
disasters, chronic mental/physical conditions, life-
    threatening disease, or addictions requires
      constant attention to self-care practices.
             Purpose and Intent
 A growing interest among educators, practitioners,
  and clinical supervisors in the identification of risk
  factors for professional impairment professional
  fatigue syndromes.
 A critical need among the helping professions to
  address early intervention for coping with the
  mental, emotional, spiritual, and occupational
  exhaustion that occurs as a natural artifact of
  providing services to others.
 Cultivate healthy coping and resiliency strategies.
       Top Ten Signs You Had a Bad
              Thanksgiving
10. You ran out of booze by 11am.
9. Most frequently used phrase at dinner: “Excuse
    me, I need to use the bathroom.”
8. Your meal was frozen left-overs from
    Thanksgiving 2006.
7. Severed your thumb on the new electric knife
    because the cousins were fighting over the
    turkey wishbone.
6. Only thing on TV:Miami (0-9) at NY Jets (1-7).
5. Your turkey is wearing a dog collar.
4. When your dinner came out, so did your
   Aunt Ginny.
3. You woke up from a tryptophan-induced
   sleep and found yourself naked in the
   neighbors backyard.
2. Your turkey dinner came from a box
   labeled “Bojangles.”
1. You had to show-up to work Monday and
   you still had relatives at your house 
 Empathy Fatigue: A Concern for the
       Helping Professions
 APA - Advisory Committee on Colleague Assistance Impaired
  Professionals.
 AMA- Physician Impairment: “physical, mental, and behavioral
  disorder that hinders the physician‟s ability to safely treat
  patients safely.”
 American Nurses Association- “Compassion Fatigue”.
 ACA Task Force on Counselor Wellness and Impairment:
- Educate counselors on prevention strategies
- ID resources counselors
- Intervention and treatment recommendations
- Advocate for professional counseling associations to establish
  programs on counselor impairment
     Empathy Fatigue: A Combination of
    other Professional Fatigue Syndromes
 Countertransference: the unconscious absorption of the patient‟s
  issues, involves a type of symbolic or parallel experience of emotional
  button-pushing. It results in a sense of anxiety, stress, sense of loss,
  grief, and over-identification w/pt. (Jung et al.)

 Burnout: a negative shift in the way professionals view people they
  serve. A cumulative emotional exhaustion, depersonalizaiton, feelings
  of a lack of personal accomplishment resulting in a loss of
  compassion, genuineness, and concern for the patient. (Maslach;
  MBI)

 Compassion Fatigue: An acute stress reaction unhealthy form of
  countertransference results from emotional, mental, and physical
  exhaustion. (Figley; Stamm, et al.)
        Empathy Fatigue (EF)
“ A dynamic state of psychological,
  emotional, social, physical, occupational,
  and spiritual exhaustion that occurs on a
  continuum, resulting from the helpers’ own
  wounds that are continually revisited by
  their client’s life-stories of stress, chronic
  illness, mental/physical disability, trauma,
  grief, and loss.”
       Theory of Empathy Fatigue
 Persons who work in “high touch” professions are more
  vulnerable than those that don‟t…
 A natural artifact of working with patients that have
  intense acute and chronic physical conditions, mental
  health conditions, and behavioral health issues.
 Many times an unconscious process where the
  professional and those around them may not recognize.
 EF is cumulative and ranges on a continuum of low,
  moderate, and high levels of physical-emotional-mental
  spiritual, and occupational exhaustion.
  The Nature of the Helping Profession

 Requires facilitating empathic approaches, cultivating client
  connections and relationships where we must attend, listen, act
  empathically to help our clients unfold the multiple layers of their
  stress, grief, loss, or traumatic experiences by searching through
  their emotional scrapbook.
 The search for personal meaning and purpose of our client‟s pain
  and suffering may contribute to the helper‟s spiritual fatigue
  experience.
 If professional helpers are mindful of this experience, and view
  this as an opportunity for nurturing personal growth and
  development, then they will learn resiliency strategies that can
  help to replenish their wounded spirit.
    The Wounded Healer Experience:
          Healing the Spirit
 Traditional Native American teachings “each time
  you heal someone you give away a piece of
  yourself until at some point you require healing.”
 The phenomenon that takes place between client
  and therapist when the therapists own
  psychological and emotional wounds are opened
  by listening to their client‟s story. (Jung)
               Healing the Spirit
 Wounded healer experience (Nouwen, 1972) “When
  our souls are restless, driven by other conflicting stimuli
  and worries…withdrawn into ourselves…how can we
  possibly create the room and space where someone else
  can enter freely without feeling himself an unlawful
  intruder?”
 (Miller, 2003) suggests client stories of addictions,
  physical or sexual abuse and psychological trauma can
  adversely affect the mind, body, & spirit of the healer.
  Wounded therapists have vulnerabilities too- we have
  responsibility for disclosing our wounds along side our
  clients…
    The Nature of Empathy Fatigue
 Dalai Lama (1999) suggests counselors can
  become exhausted by their duties because of the
  constant exposure to the suffering of others and
  can induce feelings of helplessness and despair.
“Empathy is really what we are describing when we talk
  about compassion fatigue and that it is the simple
  compassion a person experiences when they want to see
  another person free from suffering.”
       Share Your Experiences as a
           Professional Helper
1. I chose the profession/career I am in because…
2. I am encouraged by my clients‟/patients‟ success when I
   see that they…
3. My mind, body, and spirit is most affected by
   clients‟/patients‟ who are…
4. I work best and my needs are met when I have…
5. I do not work well under conditions that involve…
6. If I could make any change(s) in my career/job I would
   like to…
         EF Risk Factor Functional
                Assessment
   Personality Traits
   History of MH Problems
   Maladaptive Coping Behaviors
   Age and Experience-Related Factors
   Organizational Factors
   Job Duties within the Organization
   Socio-Cultural Factors
   Person’s Response to Past Events
   Level of Support
 Empathy Fatigue: Critical Pathways
 Impairment in professional helpers who uses empathy-
  focus therapeutic interactions.
 Communication (verbal/non-verbal) between clients and
  professionals during therapeutic interactions that are
  integrated in the professional’s thoughts and feelings and
  becomes associated as a physical-emotional reaction.
 Multiple interaction of personality traits, coping resources,
  developmental level of helper, and opportunity (or lack of)
  to build resiliency organizational-environmental supports.
 Experienced by helpers as an acute, chronic, delayed onset
  reaction ranges on a continuum.
 Experienced by helpers dealing with a variety of issues-
  daily hassles to addictions, trauma...
 Cumulative effects that lead to deterioration of counselor’s
  coping abilities and resiliency.
 Case Illustration of Nurse Ratchette
While we were in nurses training, we were always told to
 “be professional.” No one ever said exactly what that
 meant, or how to be a professional. I guess we thought
 it meant being cool and calm under pressure, objective
 with our patients, and not to get easily rattled by things.
 But I did get rattled and upset at times- like the first
 time a patient died. I would be feeling panicky, angry,
 and sad but I would be fighting any expression of those
 feelings because I knew they were not “professional.”
        Nurse Ratchette {continued}
Everyone else seemed to be handling things okay,
  which made me feel even worse- like a real
  failure- like someone who wasn’t cut-out for this
  kind of work. I didn’t dare say anything for fear
  people would find out how weak I really was. It
  wasn’t until much later in my career that I
  discovered that most everyone else was just as
  scared and lonely as I was when it came to death
  and dealing with trauma cases.
 Summative Philosophy of EF
It is not necessarily the nature of the client’s/patient’s
stress, trauma, loss, grief, daily hassles, coping, or
disability adjustment issues that creates a sense of EF;
rather it is the professional’s perception towards that
particular patient’s personality traits/states and
behavioral characteristics that determines the
professional’s response to it; and it is determined by
multiple factors that lead to a diminished capacity to
listen, respond empathically, provide competent
professional services…
         Empathy Fatigue: The Mind-Body
       Connection within the Emotional Brain
* Neuro-scientist, Dr. Joseph LeDoux’s revolutionized our
understanding of the neural pathways of the brain.
* Pre-determined chemical and electrical impulses {Amygdale} are
triggered when we perceive emotions {fear, stress, and anxiety}.
*Amygdala {our home security system} and hippocampus {seat of
emotions} sends out an emergency call to our sympathetic nervous
system and involves an all-out body system response.
* A fight-flight response triggers increase blood flow to muscles,
activates our cardiovascular system, and secretes stress hormones-
epinephrine and norephinephrine heightens reactivity to stress.
* End result – hypothalamus region of the brain, acting through the
pituitary gland stimulates the neuro stress hormone Cortisol, which
depresses overall brain functioning, can be toxic to tissue at high levels,
depresses memory, learning, and are markers for depression and anxiety.
Peripheral/ANS: Sympathetic-
  Parasympathetic Nervous
 The Neuroscience of Empathy Fatigue:
         Our Emotional Brain
 There are discrete, basic, and universal emotions that
  persons react to on a M-B-S level;
 Emotions involve different body systems which arouse
  our parasympathetic and sympathetic system;
 Chronic activation of the nervous system (stress
  response) has both a physiological and emotional cost;
 80% of all physical illness is cause by stress (Kabit-Zinn,
  1990; Sapolsky, 1998; Selye, 1976; Weil, 1995)
Why Zebras Don‟t Get Ulcers
A Video Presentation of Stress
               Zebras
               Cortisol




Hypothalamus               Adrenaline




               Pituitary
 Q. Why Zebras Don’t Get Ulcers
Answer: Zebras don’t have cumulative stress

“If you constantly mobilize energy, You
  never store it; Your muscles waste
  away; Your vascular system is under
  constant pressure; and constant
  Cortisol production turns off growth
  factors and can harm every system in
  the body…”
  The Problem with Too Many
Unhealthy Thoughts, Perception &
       Feelings: Stress !!!
 Excessive, recurrent, and intense emotional
  arousal;
 Repeated reactivation of our perceptual-
  cognitive-affective response;
 Stored unhealthy thoughts, perceptions, and
  emotions, become a worn neural pathway which
  leaves an imprint on our cognitive unconscious
  and causes a mind-body interaction.
The Critical Stress Factor in Disease:
Optimizing the Healing System {Dr. Weil}
               Lack of Energy
               Poor Circulation
            Restricted Breathing
             Impaired Defenses
               Toxic Overload
                     Age
       Thoughts, Perceptions, Cognitions
             Spiritual Problems
        Solution-Focus Prevention
 What would this problem situation look like if you were
  managing it better?
 What changes in your present situation/life would make
  sense right now?
 What would you be doing differently with your
  problem situation if you were to make the changes you
  wanted to make?
 What things have you thought about that would make
  life better for you right now?
 What things/feelings in your life would you like to
  eliminate right now?
 If you eliminated certain things in your life what would
  that feel like?
 When do you plan on making these changes?
    Changing the Stress Response:
    Protective Factors & Resiliency
 Feeling some degree of internal control;
 Exerting some control over your environment;
 Increasing your level of information and awareness;
 Changing your thoughts and perceptions;
 Shifting from mindless (unconscious) reaction to
  mindful recognition;
 Creative solution-focused problem-solving;
 Support from others in our socio-familial environment;
 High-ranking Baboon; Not living alone !!
            Locus of Control

http://www.dushkin.com/connectext/psy/ch11/
  survey11.mhtml
            Empathy Fatigue Resiliency Quiz
     1= not true of me….5=exceptionally true of me
As a professional counselor I perceive myself to be…

1.   Resilient, adapt quickly to new client issues as they arise,
     and good at bouncing back after listening, attending, and
     responding empathically to my clients’ stories all day.
2.   Optimistic, perceive that my client can increase their level of
     adaptive functioning regardless of how difficult their issues
     are, and I anticipate that things will turn out well for them.
3.   Calm and focused while my client’s life is in crisis.
4.   A good problem-solver by facilitating appropriate
     interventions by empowering my client with good resources.
5.   Able to trust my clinical intuition and facilitate creative
     solutions to my client’s stressful life-challenges.
               Resiliency Quiz (continued)
6.Self-confident, optimistic, enjoy healthy self-esteem, and
   have an attitude of professionalism about my work.

7. Playful, humorous, have the ability to laugh at myself.

8. Curious, facilitate good interviewing skills, have a desire to
   understand how things work in my client’s life, and consult
   with others when I need help.

9. Constantly learning from my past mistakes during therapy
   and from the mistakes that I see other therapists make.

10. Flexible, and feel comfortable with things that are
  somewhat complex in my client’s life, and can adapt to
  various client behaviors and personalities in my counseling
  practice.
          Resiliency Quiz (continued)
11. Able to anticipate when my client will develop
  specific problems and I have confidence that I will
  know how to deal with the unexpected.
12. Able to personally deal with my client’s negative
  or dysfunction life patterns and the ambiguity or
  challenge this presents in my own life.
13. Non-judgmental, a good listener, possess good
  empathy with my clients, express my feelings and
  be able to “read” other people well.
14. Able to recover emotionally from my client’s
  losses and setbacks, and let-go of negative feelings
  that I may have and how to ask others for help.
          Resiliency Quiz (continued)
15. Durable, keep on ticking after tough
  client sessions and possess an balanced
  and healthy fighting spirit.
16. Stronger and better after facilitating
  interventions with difficult clients issues.
17. Able to discover some meaning in my
  own life at the end of the day, even after
  hearing multiple client stories of stress,
  trauma, addiction, anxiety, and
  depression.
     Empathy Fatigue Resiliency Quiz Scoring

75 + = Very Resilient!!

65-75 = Resilient more than most counselors.

55-65 = Slow to rebound- but adequate.

45-55 = Whoa- I’m struggling as a counselor.

45 or less = I should leave now and seek help!
       Resilient Professionals
 Convey a sense of genuine commitment and confidence to help
  with their client‟s stress levels and critical issues;

 Communicate competence and have a good sense of mastery
  with handling challenging and difficult clients;

 Feel optimistic, positive, and energetic about the good work they
  do and have good coping resources;

 Have a purpose-driven life, find meaning with their profession
  and practice good self-care techniques;

 Maintain excellent interpersonal insight and still have the
  capacity for warmth, caring, and empathy.
      The Resiliency Advantage
                      Dr. Al Siebert


1. Making conscious choices in life.
2. Power of Positive Thinking.
3. Take responsibility.
4. Internal locus of control.
5. Self motivate yourself.
6. Don‟t fear trying-out new things.
7. Take control of your life.
8. Practice positive approaches to life.
 A Paradigm Shift in Conventional -
   Traditional Self-Care Practices
Historically:

 1960s: Human Potential and Personal Growth Movements began in Big
  Sur CA- Eslen- strategies for empowerment, creative problem solving,
  happiness, self-actualizing.
 1970s: Birth of New Age movement & the Self-help book.
 New Age movement both Western paradigm cognitive-behavioral and
  humanistic based, and Eastern philosophies – Goal of achieving M-B
  wellness- but criticized as a pseudoscience, overuse of psychobabble,
  and too New Aggie
 During 1970s: collaborative interdisciplinary approach with
  psychology, neuro- biological, immunology (psychoneuroimmunology)
  gave-way to biopsychosocial models of health and healing - CAM/IM
  (600+ healing txs).
 Late 1970s significant growth in transpersonal psychology-the esoteric,
  developing psychic-intuitive abilities, secular mysticism, Native
  American traditions.
       Native American Teaching

 “Every time you heal someone, you give a piece of
    yourself away, until at one point you will need
                  healing yourself”
* Shaman or Medicine Man/Woman in many indigenous
   cultures understood that in healing practices the healer
   sometimes must takes-on the pain and suffering of
   others while planting the seeds for transformation.
* Each personal transformation should bring about the
   necessary experiences for handling the next crisis so the
   mind, body, and spirit can be transformed.
     Old World vs. New World
             Shaman
 Old world shaman live in a world different from their
  people, so they may have a clear vision of what to do –
  what direction to take with their people.
 All activities are spent in developing faith, spiritual
  awareness, rituals to protect and heal M-B-S.
 Shaman carry-on traditional teachings: storytelling, talk
  circles, pipe ceremonies, prayers, dancing, singing.
 Shaman specialize in finding meaning and purpose for
  tribal members.
        Post-modern Self-Help

 New (Old) Age has ignored or neglected the
  ancient and collective wisdom of indigenous
  cultures.
 A Calling for getting back to the roots of
  community, family, ext family, connections.
 Professional helpers live in a much more intense
  world today post- Sept. 11th
 More is required in preparing for handling critical
  incidents (natural person-made disaster response)
       Show-up

     Pay Attention

Be Open to the Outcomes
Wellness Assessment

    Breathing

    Meditation

   Visualization
     Adaptive Coping & Healing
     Strategies: Organizational
• Skilled & Competent clinical
  supervision
• Mentoring approaches
• Peer-supervision
• Shift focus of treatment team meetings
• Re-structure organizational philosophy
  to a healthy person-centered {M-B-S}
The Human Energy Field and Emotions

 There is a relationship between the energy
  field of the heart and emotional states.
 The expression of love, compassion, fear,
  anger, and anxiety produces a particular
  harmonic frequency within cells of the body.
 Emotions in general can be communicated (or
  projected) by others (empathy & compassion).
 Laying on of hands create frequencies that
  stimulate immune functioning, CNS,
  neurotransmitters (give me a hug).
     Body Energy Work and the
       Human Energy Field
 A fundamental law in physics, Ampere’s
 Law, states when currents flow through
 conductors (wires or living tissues), then
    magnetic fields are produced in the
            surrounding space.
Electro-Chemical impulses occur naturally
 in the brain, peripheral nervous system,
   heart, and in all muscles of the body.
 Quantum Healing, Energy Medicine,
Body Energy Work- and the Physics of
              Reiki
 Pulsing Electromagnetic Field Therapy
  (PEMF) for healing muscular skeletal
  conditions (TENS Unit), cardiovascular
  disease (Pacemakers) have been established in
  mainstream medicine.
 Electromagnetic signals are emitted from the
  hands of trained healers; biomagnetic energy
  field produced by a practitioner’s hand can
  induce current flow into tissue and can be
  measured; “The Electricity of Touch.”
        A Very Brief History of REIKI
Dr. Mikao Usui   Dr. Chujiro Hayashi   Mrs. Hawayo Takata
(1865-1926)           (1870-1941)          (1900-1980)
         Intention of REIKI:
To:
 Balance and harmonize
  the body’s own natural
  healing energies.
 Release ones’ emotional
  energy blocks.
 Facilitate and increase the
  body’s ability to achieve calm
  and meditative states of consciousness.
    NIH- National Center for
  Complementary and Alternative
      Medicine (NCCAM)

 Biofield Therapies: Those therapies intended to
  affect energy fields that purportedly surround
  and interpenetrate the human body (Reiki,
  Qigong, T.T.)
 Bioelectromagnetic-based Therapies:
  Manipulation of electromagnetic fields, invisible
  lines of electrical force or currents (magnetic
  therapies)
                 REIKI
    “Reiki is God’s love in its purest form. It is
completely unconditional. It demands nothing
of the giver nor of the receiver. It professes no
creed or dogma. It requires no specific belief in
the supreme being or in Reiki itself. Used in its
traditional form, as developed by Dr. Usui in
the Usui System of Natural Healing, Reiki heals
the body and emotions, bringing them into
balance and promoting health, happiness,
prosperity, and long life”
  How Does the REIKI Practitioner
             Work?
 Practitioner gently places hands on or just
  above the body to channel REIKI or
  Universal Life Energy to the different
  Chakras or parts of the body that function as
  a focal point for spiritual energy.
 Practitioner acts primarily as a conduit or
  vessel to channel REIKI in a powerful
  concentrated form.
       Touch Research Institute
              University of Miami

 Physical contact prompts the relaxation
  response endorphin release
 Physiologically the person releases
  serotonin and dopamine to slow down the
  secretion of the stress hormones
  norepinephrine, epinephrine, and cortisol
Dr. Harry Harlow‟s Monkeys
   Attachment as the Foundation of
       Hardiness and Resiliency
 Poorly attached children exhibit higher
  levels of agitation
 low impulse control
 poor at social and interpersonal
  relationships
 have higher rates of illness and mental
  health problems
        REIKI Research
http://www.reikimedresearch.com/

   International Center for Reiki
              Training

       http://www.reiki.org
              Body Chakras
 Each of the seven (7) body chakras
  represents a vital life force “Ki” that relates
  to different body systems.
 Blocked chakras lead to emotional, mental,
  physical, and spiritual imbalances.
 Too much energy, too little energy, or
  blocked energy within the body chakra
  requires a harmonizing or re-balancing
7th- Crown {Consciousness,
         Spiritual awareness}


6th- Third Eye {Intuitive/Inner vision}

5th- Throat {Self-expression}

4th- Heart {Love of self/others}

3rd- Solar Plexus {Power, Strength}

2nd- Sacral {Self-esteem, Relationships}

1st- Root {Survival, fertility}