Let’s Talk About Burnout, Compassion Fatigue and Vicarious Trauma

Helping professionals do an excellent job of breaking down the stigma surrounding mental illness. However, when we look in the mirror, we are not quite as good at applying those same stigma-fighting and self-compassion principles. There is a tendency for helpers to place the needs of others above their own needs.

We will fight incredibly hard to help others enjoy peace, health, and their human rights, but in order to do so we often compromise our own peace, health, and human rights. We spend our working days carefully listening to the needs of others, deaf to the screams of our own hearts and bodies. Ashamed of the humanness that has prevented us from living up to the SuperHero image of helping professionals, we are wary of sharing our own stories.

Unwilling to share our vulnerable selves, the stories we do release for public consumption are often so heavily edited the end result resembles little more than a “once upon a time” fairytale. Let’s not contribute to the all-too-common fairytales about what it’s like to work as a helping professional. Instead, let’s talk about how it really feels to face the darkest corners of human life (and death).

Let’s talk about burnout, Compassion Fatigue, and Vicarious Trauma.

If we don’t, they will become the bogeymen that consume us. My own story of Vicarious Trauma began suddenly in 2006 when I was working as a Child Protection Officer. My ears and eyes were filled with the sounds and images of broken babies. My hands were filled with paperwork and my head was too full, too busy, to do anything except meet the deadlines that came thick and fast from all directions. The bogeyman that bit into me refused to let go and evolved into a full-blown eating disorder.

From 2008 to 2011, I was hospitalised twice and worked hard to heal my body. From 2012 to 2016, I worked hard to find the words I’d buried, match them with feelings, piece it all together and also work up the courage to share my precious story with strangers.

Without a doubt, the research and writing I undertook during those four years were the most agonising and significant steps I took toward recovery. I began by researching anorexia. Up until my mid twenties, I’d enjoyed healthy eating patterns and body image. How was it possible for such a person to suddenly stop eating? I started with the book “Eating Disorders in Adult Women” (edited by Julian Fuchs, 2008) and moved on to the wealth of research from Steven Levenkron.

There were many references to eating disorders stemming from Trauma, but I rejected the theory that my eating disorder was the result of this. Trauma was, I told myself, something that happened to survivors of war or whose lives had been threatened under the most horrific of circumstances. I refused to minimise the awfulness of their experience by including myself within their number.

Perhaps what happened to me was “just burnout”. I pulled out Christina Maslach and referred to her extensive research on the topic. Her descriptions of burnout were familiar but didn’t quite fit my symptoms. Again, there were plenty of references to Trauma. Fine. I piled my bedside table with all the classics on Trauma – Judith Herman, Peter Levine, Babette Rothschild – never believing I’d find myself living within their pages. I did. I knew about Trauma, of course. I’d learned the basics at university and had applied the theories when working with clients who’d experienced domestic violence, sexual assault, or childhood abuse.

Reading these books was a completely different experience and everything I thought I knew about Trauma was turned on its head. I read the theories as if I were reading them for the first time. Now, I didn’t just understand the words, I felt them and knew them to be true. Since releasing “Selfless: a social worker’s own story of trauma and recovery” I’ve been privileged to hear many people tell me about their own experiences of burnout, Compassion Fatigue, and Trauma.

It’s been wonderful to be part of this burgeoning web of storytelling and it has strengthened me more than I ever thought possible. It’s my dearest wish that my book will start a conversation about how to improve the support we provide to our frontline helping professionals. There is so much more that can be done. Let’s show how much value we place on the essential services they provide.

Self Care is a Requirement

Ensuring the self care of social work staff is an organisational requirement. No matter which way you look at it, social work organisations are required to look out for the safety and wellbeing of their staff. It is a basic occupational health and safety requirement, and it is also one many organisations are failing.

Every day we meet with social workers who are burning out. Caseloads are too high and ever more complex, staff are working longer hours some even without pay and to top it off we are having to defend our jobs everywhere. Many staff feel that they can’t take holidays and many managers would prefer if they didn’t. Taking a mental health day is getting harder and of course there is a form to fill out. In short, our sector is feeling the increasing strain brought about by the neoliberalist agenda.

So what’s the solution? Revolution! As a sector we need to stop blindly following in the ways which have got us in this position. We need to find the difference. Start by making sure the organisation you work for have clear policies about staff care. If they don’t lobby for them. Put self care in your work plan. Bring it up in supervision sessions. Take your allocated holidays and advocate for more, one great organisation we know gives staff a week for reflection. Bring self care up at staff meetings.

According to the article Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 Self-Care Tips for Helpers:

Dr Charles Figley, world renowned trauma expert and pioneer researcher in the field of helper burnout has called compassion fatigue a “disorder that affects those who do their work well” (1995) It is characterized by deep emotional and physical exhaustion, symptoms resembling depression and PTSD and by a shift in the helper’s sense of hope and optimism about the future and the value of their work.

The level of compassion fatigue a helper experiences can ebb and flow from one day to the next, and even very healthy helpers with optimal life/work balance and self care strategies can experience a higher than normal level of compassion fatigue when they are overloaded, are working with a lot of traumatic content, or find their case load suddenly heavy with clients who are all chronically in crisis.

Compassion fatigue can strike the most caring and dedicated nurses, social workers, physicians and personal support workers alike. These changes can affect both their personal and professional lives with symptoms such as difficulty concentrating, intrusive imagery, loss of hope, exhaustion and irritability. It can also lead to profound shifts in the way helpers view the world and their loved ones. Additionally, helpers may become dispirited and increasingly cynical at work, they may make clinical errors, violate client boundaries, lose a respectful stance towards their clients and contribute to a toxic work environment. Read Full Article

If you are a manager, it is your responsibility to make sure your staff are looked after. We all know that the better staff are treated the more they perform. If you are a frontline worker you must look after yourself. If you don’t you are doing a disservice to your clients and ultimately the profession of social work.

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First Responder Mental Health: It’s Not All In The Mind

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Our police, paramedics, firefighters and rescue personnel help keep our communities safe. However, the general public does not view this population group as vulnerable. While in the mental health field, doctors, psychologists and social workers are seeing a very different picture with alarming suicide rates and a high incidence of Post Traumatic Stress Disorder (PTSD). Emergency services responders are trained to look after others, but not themselves. It’s a global issue, one that is being increasingly brought to light by the courage of those who suffer and their supporters speaking out.

With many helping professionals working from a traditional medical model, mental health issues among first responders tend to be identified primarily as a response to attending traumatic incidents. Treatment is inclined to be focused on therapies such as CBT, DBT, EMDR and mindfulness. These approaches focus on individual change and evidence certainly suggests that these types of treatments are invaluable in terms of strengthening the individual’s coping and resilience skills.

However, we must be mindful how the systems in which the individual functions will also have an impact on their mental health. When working with emergency services responders and their families, it is vital that therapists and health promotion workers understand ALL the factors which impact wellbeing, not just in response to mental health issues but also in developing prevention strategies.

So, what are some of these “other” factors, or determinants warranting attention when dealing with emergency services wellbeing?

1) Emergency services culture – historically emergency services culture has fostered the ‘toughen up’ attitude, deeming the admission of mental health issues as a ‘weakness’ . Admitting this weakness not only reflects on the individual but also on the ‘brotherhood’ which values pride and strength.

2) Organisational culture- whilst changes are being made in some organisations, there are ingrained fears (real or perceived) from responders that any admission of mental health issues will either deem them unfit for work, or will stop them from getting promoted.

3) Workplace Stigma– there are real and perceived fears of work colleagues judging a responder as ‘weak’, particularly if a number of them have been to the same call outs, but only one speaks out about struggling. A lack of understanding of stress responses and the individuality of conditions such as depression, anxiety and PTSD leads to judgement and alienation of the individual affected, rather than what is needed – support.

4) Societal Expectations – Let’s face it, we all grew up thinking of police, firefighters and paramedics as heroes. They’re the people who protect us, and save our lives! We’ve been taught to listen to their instructions, trust their judgement in crisis and look to them for guidance when in danger. Somehow it doesn’t make sense to acknowledge that these ’heroes’ are human just like us!

5) Lifestyle changes Whether the responder is full time, part time or a volunteer, from the moment of recruitment personal and family lifestyle require changes. Inconvenient rosters, critical incidents, unexpected call outs and changes in household roles and routines are just some of the challenges faced by emergency services responders and their families.

6) Family Support– families of first responders have unique stresses and unique expectations. But it’s difficult to discuss these stresses and expectations outside emergency services circles. Firstly there is this feeling that the general public won’t understand. More significantly, divulging that their responder family member is suffering in some way feels like they’re breaching an unwritten ‘confidentiality code’ such as don’t embarrass the organisation, the crew or the individual by speaking about individual or family mental health issues. What happens on the job stays on the job which extends to family members. There is also the old belief that telling your family about any incidents affecting you will adversely impact that family member’s mental health. Organisational confidentiality regulations support that notion – yet talking about and processing traumatic incidents is critical in any recovery process.

7) Relevant Social Support. When responders experience work related stress, they have a number of barriers to disclosing struggles to friends who are not part of the emergency services culture. One barrier is confidentiality – they are not supposed to discuss the details of their work with anyone from the general public. Secondly, there is the notion (real or perceived) that those who haven’t done the job could not possibly understand what they’ve experienced. Thirdly, there is the reluctance to ‘burden’ civilians with the graphic details of incidents for fear they may end up suffering vicariously as a result of the disclosures.

What advice can those in the helping professions take from this?

If you treat an emergency services person with depression, anxiety or PTSD without understanding the context in which their illness or injury occurred, then you are not only doing your client a disservice, but you could in fact be damaging their potential for an effective recovery. It is vital that you have a genuine understanding of emergency services culture both today and historically.

Secondly, should we as professionals not be advocating on behalf of this group? In Australia alone there are over 400,000 paid, part time and volunteer emergency services responders – add their family members and that’s a huge population group affected by unique stresses! To advocate effectively, helping professionals need to understand the systems their lives function in, and systems which impact on wellbeing and recovery.

Thirdly, there is a strong need to focus on prevention – on a global level the media are telling us there is a “mental health crisis among emergency services workers.” We’ve seen these sorts of reports for years. What is actually happening to prevent mental health issues among emergency services responders? What sorts of consultations are happening? Who is invited to these consultations? Who is the information from these consultations being disseminated to? And what are the results of these consultations “on the frontline”?

No matter what field of practice you are in, I urge you to educate yourself on ALL the factors impacting the mental health of those who keep us, our families and our communities safe.

Helping Law Enforcement the Social Work Way

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One story that is trending on news and social media is that of a law enforcement officer who drew his gun on unarmed teenagers.  The same officer was videotaped ordering teenagers to lie on the ground and was viewed physically holding a teenage girl on the ground.  The teenagers were reportedly at a neighborhood pool when an incident occurred and law enforcement was called.

It should be noted that not all of the officers approached the incident in the same manner.  Another officer was videotaped calmly but assertively asking several youngsters about the incident.  His questioning was interrupted by the officer, who eventually drew his weapon.

Comments and opinions on the blogosphere regarding this current event are emotionally charged.  They clearly show biases that originate from the writers’ life experiences and beliefs.  These opinions are often framed in combative ‘them versus us’ tones.  If one expresses concern for the law enforcement officer, another opinion will refute its validity and claim concern for the alleged victims.  If one expresses concern for the victims, another writer will invalidate the comment and express full support for all actions, good, bad, or indifferent by the law enforcement officer.

Unfortunately, these comments do not solve the problem and do not address the needs of the victims or law enforcement officers.

Law enforcement officers and first responders have been found to have a higher incidence of Post Traumatic Stress Disorder (PTSD) than the general population. In the article “What is Post Traumatic Stress Disorder” author Pamela Kulbarsh, R.N. wrote that the prevalence of PTSD ranges from 4-14% among law enforcement officers.  Many articles state that an exact number is difficult to obtain due to underreporting.

Law enforcement officers are repeatedly exposed to threats of death and actual death.  They are expected to make split second decisions that could result in major injuries or loss of life.  Officers are sent to situations with cursory information and expected to provide appropriate solutions.  Gary G. Felt, MA, MHC expounds on this concern in the article “The Relationship of Post Traumatic Stress Disorder to Law Enforcement: The Importance of Education.”

Social workers and mental health workers understand that individuals who experience PTSD symptoms may believe they are under constant threat particularly in situations that are similar to other trauma related experiences.  They may display demonstrate irritability, anger and aggression with little to no provocation.

These events provide opportunity for social work professionals to provide solutions using their knowledge and expertise of social work practice.  Professional social workers, who are entrepreneurial minded, should also view these incidents as opportunities for career growth and advancement as well.

Social workers can provide law enforcement officers with solutions and training to avert the appearance of being overly aggressive, unyielding and unreasonable.  Social workers can also provide strategies that will enable law enforcement professionals to do their jobs while providing them with substantive protection.

Social workers use social work methods and strategies.  Solution enabling strategies include:

Developing appropriate responses to problems based on client needs.

Creatively combining knowledge, values and skills to gain understanding and build relationships.

Respecting and facilitating healthy interactions among individuals, groups and environments.

Assessing, planning, implementing, and evaluating work at every level.

A partnership between social work and law enforcement will create and promote an environment of support and safety for law enforcement officers and the community at large.

Child Protection: The Cases You Live With

My first case as a social worker involved child abuse, and the father of an infant had inflicted a spiral fracture of the tibia and fibula on his child. He and the mother ended up losing their parental rights to the child, but they would go on to have other children together. It was a powerful lesson in the ability of child protection to intervene in the life of a child. But, we must understand, it is one life at a time.

child-abuseNot long after meeting that child, I would meet another. He was a boy of about 8 years old who was found early one Sunday morning, naked and wandering between garbage cans by a local beach. He was in a dissociative state. The police officer who found him brought him to the ER and showed us the boy’s emaciated body with evidence of old burn marks. It would be weeks before we learned who he was.

I thought of these two cases recently when I was looking at autopsy photos of another case. Our work in and around child protection is a world that few in our society truly understand. We are exposed to the individual horrors that one person can inflict on the vulnerable. We see things that most people would not even want to talk about.

I did my first practicum 40 years ago, and I am still proud to call myself a social worker. I am still excited by what we do. Yet I have seen social workers leave the profession because the work got too much. I have also seen workers who have stayed but shouldn’t have as they become bitter and toss their power about as retribution for the harms that they have seen.

Vicarious trauma is the right term for it, yet the term creates a sense of distance as though it is somehow a little less harmful than “real” trauma. The trauma of being a witness is real. As social workers, we speak of it often when we talk about how children are affected by witnessing domestic violence. We spoke of it when we saw the children being led from the Sandy Hook Elementary School in 2012. We again speak of it when we see people exposed to violence such as the survivors of the Columbine High School shootings, the killing of the police officers in Las Vegas just a few days ago or the cold blooded murder of 3 RCMP officers in New Brunswick recently.

In child protection, we must also acknowledge that we too are the witnesses and the victims of the violence that we experience in our work. We take it home. It lives within us. Too often we here about self care and then go back to work. To be really good at this work, we must be really engaged in being healthy and hold on to our reasons for coming into the profession. I am honored to teach social work and listen to new students each year talk about entering social work in order to help people and make a difference. If we cannot hold on to our health, we are unlikely to hold onto truly making a difference.

In order to manage vicarious trauma within ourselves, we must be willing to listen at what is going on within. Our work can change our world view to one where safety is not seen as the norm but rather risk is seen that way. As social workers, we might also remember that in the course of our day to day work we are exposed to a skewed sample. Largely speaking, people who are doing well don’t come to see us.

We must also advocate for work environments where talking about the traumas that we see and how they affect us is seen as not only ok, but also as desirable. This includes being allowed to express our grief and anger so that we can normalize not only what we see but how it affects us. A self care plan is essential, and this is nothing new. Although, I continue to see far too many colleagues forgetting themselves, and helping ourselves is also essential part of helping clients.

Everything I Know About Vicarious Trauma in Five Minutes

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I was the poster child for Vicarious Trauma at least that’s what I liked to tell myself. In the great oppression Olympics that belongs to folks who have done human services over long careers, sometimes too long, it’s a coveted moniker. Why did I think I got this title?

Several years ago, when I was at the peak of my clinical practice, I ran six group therapy sessions a week for men referred for sexual offenses, many of whom I also saw in individual and family counseling. It was all sex offenders, all the time.  Impressively–again, this is what I liked to tell myself–I could hold it together for a 50-hour work week. I  had mastered the “pose of equanimity,” as they euphemistically called it in graduate school.

But a more savvy observer might have said my “pose of equanimity”  looked more like a frozen, coma-like state of emotional numbing. When I went home, I’d fall apart: a mess of eating and sleep problems, disengagement from family and spouse, flashbacks, startles responses, and nasty dreams. My gastrointestinal tract was a roller derby rink.

Of course, this notion of an oppression Olympics where I get the gold medal is foolish.  Even though I know this to be true in my heart, nevertheless, as I go about, years later, as a consultant facilitating dialogues about vicarious trauma at human services agencies, I notice that other folks in my field jockey for the same distinction.  I’m not the only social worker vying for this same validation. Among ourselves, we social workers love to tell war stories.

Generally, when social workers launch into tales of the “worst of the worst” stories of what they’ve seen with disadvantaged and troubled clients, I recognize a very human tendency:  that longing for validation of one’s suffering and appreciation for one’s personal sacrifices within beleaguered, feedback-starved environments. There’s something about thinking that my professional travails are the worst that is validating, even sustaining, bordering as it does on the heroic.

Now that I’ve affirmed my recognition that I think the oppression Olympics is a fallacy, I do want to note the two times I trained at agencies when I actually thought for a moment they really should get the prize. One was at a local program that works with a high volume of undocumented, impoverished immigrant families. I had never seen social workers embedded in such intensity of critical, unmet needs. The system was so closed and the resources were so paltry.

The other experience was at the drunk tank in my town, where inebriated folks are kept on 48-hour holds to get them off the street. The Emergency Medical Technicians had cleaned out one of the dingy, concrete-walled tanks for me to set up my laptop and infocus machine. While I clicked through my slides, I could hear the fury of involuntarily confined drunk people in the adjoining locked cells, screaming “FUCK YOU! LET ME OUT OF THIS HELL HOLE!” at the top of their lungs. My training group of twenty participants didn’t even flinch.

When I heard about the Portland Ignite event, it seemed like an opportunity to connect the common experience of vicarious trauma, which is epidemic in our field, with another event World Social Work Day on March 18th. Of course, I had known about World Social Work Day for years in the same way that I knew about National Doughnut Day (First Friday in June), Pi Day (March 14th), and National Tattoo Day (June 5th). Why did World Social Work Day exist, I used to wonder, if no one, at least in my experience, really did anything about it? Having another bogus, fluffy holiday seemed to trivialize the hard work we do.

I always tell my social work colleagues that the antidote for vicarious trauma consists of three strategies: authentic connection with fellow travelers, exceptional self-care, and validation by our organizations of the work we do. I decided to get up at Portland ignite because I wanted to send a 5-minute message of deep gratitude to all social workers as well as appreciate all the folks who do social work without the benefit of a formal social work degree.

So here it is “Strong @ the Broken Places.”  Everything I know about vicarious trauma in five crisp minutes (20 slides, 15 seconds each, no stopping, no second chances). Happy World Social Work Day everyone!

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