Empathy Fatigue_ Healing the Mind_ Body_ and Spirit of Professional

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					Empathy Fatigue: Healing the
  Mind, Body, and Spirit of
    Professional Helpers
      From Empathy Fatigue to
         Empathy Resiliency
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 Iraq (4348 Am Military casualties) Afghanistan
  (796 Am); 84K Iraqi Civilian deaths (320,000 AM TBI)
 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 (323 deaths ‘92-’2007)
 4.2 mil worldwide living with AIDS
 3.1 AIDS-relates deaths
          Etiology 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
       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.
          Empathy Fatigue (EF)
“ A dynamic state of physical, psychological,
  emotional, social, 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 chronic illness, mental/physical disability,
  trauma, grief, and loss.”
    Empathy Fatigue Reactions and
       Impaired Professionals
 APA – Impaired Professionals
 AMA- “Physician Impairment”: “physical,
  mental, and behavioral disorder that hinders the
  physician’s ability to safely treat pts.”
 ACA- Task Force on Counselor Wellness and
 American Nurses Association
       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, and behavioral 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.
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: An Updated Guide to
   Stress, Stress-Related Diseases, and Coping
                 Dr. Robert M. Sapolsky
 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 Cost of Being a Stressed
       A study of 27,000 people in 50
      different countries found that people
          with significant stress levels

           OF HAVING A
          HEART ATTACK

(2004 Interheart study with 50 participating countries)
  The Problem with Too Many
Unhealthy Thoughts, Perceptions &
  Feelings: Empathy Fatigue !!!
 Excessive, recurrent, and intense emotional
 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.
Hindu Parable: The Monkey and the Banana
             Critical Pathways
 EF has both an acute, chronic, or delayed onset
  reaction that ranges on a continuum of low,
  moderate, and high;
 Communication (verbal/non-verbal) that is
  exchanged between clients/patients and
  professionals during therapeutic interactions are
  integrated in the professional’s thoughts and
  feelings and becomes associated as a physical-
  emotional reaction
  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
 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.
      Share Your Experiences as a
          Professional Helper
1. How did you chose the helping profession?
2. In what ways are you encouraged or discouraged
   by your clients’ successes or failures?
3. How is your mind, body, and spirit most affected
   by intense interactions with others?
4. Describe any self-care you do and how you
   cultivate resiliency?
         EF: 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.
 Compassion Fatigue: An acute stress reaction
  unhealthy form of countertransference results from
  emotional, mental, and physical exhaustion.
Professional 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.
               Signs of Burnout
Feeling …..
 Tired and out of energy
 Worthless
 Emotionally out of control
 Constantly negative
 Alone and disconnected
 Depressed
 Stressed
 Anxious
 Substance abuse-addiction
  Summative Philosophy of EF
It is not necessarily the nature of the client’s stress,
trauma, loss, grief, daily hassles, coping, or
disability adjustment that creates a sense of EF for
the professional; rather it is the professional’s
perception towards that particular client’s; and the
helper’s personality traits, states, and behavior that
determines the response; which is determined by
multiple factors that lead to a diminished capacity to
listen, respond empathically, provide competent
professional services…
         EF Risk Factor Functional
   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 Resiliency Quiz
     1= not true of me….5=exceptionally true of me
As a professional helper 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 interventions, 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 others 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.
          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 a 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
     Empathy Fatigue Resiliency Quiz Scoring

75 + = Very Resilient!!

65-75 = Resilient more than most helpers.

55-65 = Slow to rebound- but adequate.

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

45 or less = Leave now and seek help!
       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.
                   Loss of concentration,
                   lack of focus
Cognitive Signs
  of Distress
                  Apathy, lacks meaning
                  in chosen profession

                  Preoccupation with
                  avoiding job tasks
               Feelings of exhaustion,
Emotional      lack of energy, sleep
 Signs of
Distress    Emotional roller coaster of
            highs and lows, feelings of
            being overwhelmed

            Irritability, agitation,
            anger, resentment,
             isolation, detachment
  Being on edge, very
       impatient         Signs of
Feeling extremely        Distress
cynical, bad sense
of humor

Changes in eating
and grooming habits,
poor lifestyle
                Stomach aches,
Signs of        Headaches

Distress   Shallow breathing,
           rapid pulse, heartbeat

           Increased illnesses
           due to lower
Interpersonal        Withdrawal from
   Signs of          colleagues

                 Projection of anger or
                 Blame, increase in inter-
                 personal conflicts

                Poor communication
                skills with family,
                personal relationships
              Loss of meaning and
Spiritual     purpose with self and
Signs of
Distress    Decrease in spiritual
            and religious activities

            Loss of faith in
            higher Power, cynical
            with past faith and
                    Decrease in quantity
  Signs of          and quality of work

 Distress      Low motivation, avoid
               job tasks, increase in

               Increase in mistakes
Case Illustration of Mental Health
“While we were in counselor training, we were always
told to “be competent professionals.” No one ever said
exactly what that meant, or how to be a mental health
professional. I guess we thought it meant being cool
and calm under pressure, objective with our clients, and
not to get easily rattled by “crazy persons.” But I did
get rattled and upset at times- like the first time a client
attempted suicide. Somehow I felt responsible and felt a
mix of anxiety, anger, and sadness but I would be
fighting any expression of those feelings to my
colleagues because I knew that this was not the
“professional thing to do.”
      MH Professional{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 see 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, sad, and angry as I was when it came to
persons who have chronic and persistent mental
health issue are those who have be traumatized”

     Pay Attention

Be Open to the Outcomes
        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?
The Critical Stress Factor in Disease:
Optimizing the Healing System {Dr. Weil}
               Lack of Energy
               Poor Circulation
            Restricted Breathing
             Impaired Defenses
               Toxic Overload
       Thoughts, Perceptions, Cognitions
             Spiritual Problems
    The Organization’s Responsibility in
•   Skilled & Competent clinical supervision
•   Mentoring approaches
•   Peer-supervision
•   Shift focus of treatment team meetings
•   Re-structure organizational philosophy to a
    healthy person-centered wellness
    Expression of Feelings
Expressive Drawing “Emotional
            Journal Writing
 Spontaneous writing
  (dreams, fantasies)
 Open and honest
 Accept whatever
  comes to mind
 Grammar- spelling
 Process is just for You
 Reducing Workplace Stress: It’s 15% Effort,
Productivity, and Showing-up - 85% Attitude!
 Wake up and affirm that you have a job (15.1 mil
  Americans or 9.8 are unemployed)
 Leave your house with a heart full of gratitude (may
  require some morning ritual)
 Recognize the range of opportunities and be open to all
  the possibilities that your employment brings
 As you travel to work be aware of how you cultivate-
  prepare your mind, body, and spirit for your profession
 While at work take a moment to be aware of how you are
  cultivating and preparing your m-b-s for your profession
 Cultivating-Preparing M-B-S for Your
 Be mindful of the toxins you take-in your M-B-S
 Lunch- an important part of your day- use it wisely
 Be aware of how you communicate with others
  throughout your day (verbally and non-verbally)
 Get good closure with people, job tasks, and organize
  yourself for tomorrow- leave your work personality and
  behaviors-at work
 Get out of your work clothes immediately when you get
  home and allow yourself to transition into your home
 Brrreeaatthh!!!

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