COMPASSION FATIGUE

A PAPER SUBMITTED TO THE FACULTY OF TEMPLE BAPTIST SEMINARY IN CANDIDACY FOR THE DEGREE OF DOCTOR OF MINISTRY

CRISIS INTERVENTION PAST 7433SP

BY KEATING WILLCOX

SOUTH HAMILTON, MASSACHUSETTS APRIL 29, 2011

CONTENTS
CHAPTER I INTRODUCTION...................................................................................................................1 CHAPTER II. BACKGROUND ..................................................................................................................1 DESCRIPTION OF COMPASSION FATIGUE................................................................................................................2 CONCERNS TO CONSIDER IN COMPASSION FATIGUE...............................................................................................3 CHAPTER III. MY COMPASSION FATIGUE.........................................................................................3 RECOGNIZING COMPASSION FATIGUE IN MYSELF..................................................................................................3 MY PLAN TO AVOID COMPASSION FATIGUE BURNOUT WORK............................................................................5 MY PLAN TO AVOID COMPASSION FATIGUE BURNOUT FAMILY...........................................................................7 MY PLAN TO AVOID COMPASSION FATIGUE BURNOUT - FAITH..............................................................................8 CONCLUSION...............................................................................................................................................8 BIBLIOGRAPHY...........................................................................................................................................9

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CHAPTER I INTRODUCTION Compassion fatigue is a term with several popular definitions. An early public use of the term describes the publics impatience with the homeless problem in that charitable efforts to reduce homelessness seem to be met with resistance, and delay.1 A later version of this same frustration with charities was the public response to the Red Cross after 9/11.2 The Red Cross had given only a third of its donations to the intended recipients. Other charities receive bad reviews for expensive executive salaries and large marketing budgets.3 Other definitions of compassion fatigue are the effects in both legal and veterinary professions, such that professionals in both professions have a high degree of burn-out related to the stress of the profession.4 Some estimates indicate that lawyers suffer depression as much as 400% more often as the general public. Suicides are more prevalent as well. The compassion fatigue we speak of in this paper uses the concept of compassion fatigue as first described by Figley.5 CHAPTER II. BACKGROUND

Public Knowledge, Attitudes, and Beliefs About Homeless People: Evidence for Compassion Fatigue., (accessed April 28, 2011); available from http://www.ncbi.nlm.nih.gov/pubmed/8546109?dopt=Abstract 2 Red Cross Defends Handling of 9/11 Donations, (accessed April 28, 2011); available from http://articles.cnn.com/2001-11-06/us/rec.charity.hearing_1_liberty-fund-red-cross-relief-agency? _s=PM:US 3 I was asked about giving to the United Way. My response was that the United Way and Red Cross each paid their top executives over $500,000 salary, but the Salvation Army top executive only got $35,000. I asked the questioner which charity he thought deserved the money. 4 Lawyers with Depression, (accessed April 28, 2011); available from http://www.lawyerswithdepression.com/default.asp 5 Charles R. Figley, Compassion Fatigue : Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, Brunner/Mazel Psychosocial Stress Series (New York: Brunner/Mazel, 1995).

Description of Compassion fatigue

Compassion fatigue is a component of burn out. The term comes from patients who were burned out physically, emotionally, spiritually, interpersonally, and behaviorally to the point of exhaustion.6 A burnout is experienced as a state of physical, mental, and emotional exhaustion caused by long-term involvement in emotionally demanding situations.7 Burnout is not generally perceived as a crisis event because its onset is slow and insidious.8 A burnout can occur from six sources, such as workload, control issues from being micromanaged, lack of reward through compensation, and absence of community, a lack of fairness, and discordant values that indicate you and the organization are severely at odds.9 Burnout can be found in three levels: trait, state and activity. The trait level is all-encompassing, and the worker is non-functional.10 The state level indicates a periodic or situational burnout, and the activity level is related to an activity that is repeated over and over.11 Burnout begins with enthusiasm, then stagnation, then frustration, and finally apathy.12 A related problem is counter-transference, when a worker is so emotionally involved with a client and begins to see his or her shortcomings, fears, and prejudices in the client, that the worker begins to act in inappropriate ways. Some clinicians believe that countertransference is a useful tool, and others find it as a hindrance to a proper therapeutic relationship.13

Richard K. James, Crisis Intervention Strategies, 6th ed. (Belmont, CA: Thomson Brooks/Cole, 2008), 531. 7 Ibid. 8 Ibid., 532. 9 Ibid. 10 Ibid., 535. 11 Ibid. 12 Ibid., 537. 13 Ibid., 538.

When an individual begins to mimic a clients trauma related symptoms, this is vicarious traumatization. This effect, in combination with compassion fatigue, are each major components of burnout.14
Concerns to Consider in Compassion Fatigue

Some of the concerns with compassion fatigue include the organization or agency that employs the worker with burnout. Such workers feel that they have little control over their jobs, lack autonomy and are unclear about agency objectives and have a big workload.15 For private practitioners, there are additional factors. Many such practitioners are type A personalities, with the autonomy and loneliness that creates an opportunity for burnout. Long hours and difficult work periods are the rule, not the exception.16 CHAPTER III. MY COMPASSION FATIGUE
Recognizing Compassion Fatigue in Myself

Compassion fatigue, for me, would come from the realization that everyone I work with in the Heart Disease and Stroke ministry is in the crisis of their life. The onset of symptoms and the guidance of a team of physicians can only do so much. Eventually we all die, but a patient with heart disease or signs of impending stroke, has a sword of Damocles over their head for the remainder of their life. As they go through a crisis of health, life, family relations, unmet dreams, and enormous financial expenses at a time of life when it is less possible to earn a lot of money, the psychological and spiritual soul of the client and their family begin to falter.

14 15

Ibid., 539. Ibid. 16 Ibid., 547.

As they realize how few people want to help them, and that I am one of the few who can share their stories, our relationship can quickly grow way beyond sensible emotional limits. Demands made on me by someone who has a very short time to live are hard to turn away. I need to make sure I have a father confessor who can inform me of any tendency for burnout. I do believe that 24/7 access is essential. Heart attacks and strokes often happen in the early hours of the morning, and there are times when a medical emergency simply overwhelms the need for privacy. Another issue that I have is that I rarely take a vacation. Thats not so bad, as the area I live in is a summer destination for tourism, and provides plenty of fun, without having to travel. A disadvantage is that work never really stops, and I am never off duty. Part of my good fortune is that the advice and help I offer is very structured. I tell clients the common sense items that are helpful to all. For example, my initial advice is to establish the names addresses of all the clients physicians, and make a complete list of medications and exercises. So often, prescriptions are given by physicians who are unaware of the treatment of the client from other physicians, so it is not unusual to find clients taking dozens of medications, many that act against the others. It is also my good fortune that my clients are really interested in Jesus Christ, and the prospects for their life after their physical death. In this regard I can discuss apologetics and faith, repentance, restoration, and forgiveness, offering the gift of living water to someone who knows they will need it soon. The impending finality of heart disease also creates opportunities for clients to restore their relationships with friends and

family members where there may have been a rift of some sort. Christian denominations become less critical and differences melt. In this manner, I have the best of both worlds. I am helping a client prepare sensibly for the remainder of their life, and for a life in paradise. I need not immerse myself emotionally with each client, as I am not really trying to change them. I am their maven.
My Plan to Avoid Compassion Fatigue Burnout Work

My first element for compassion fatigue burnout is the same advice I give everyone for longevity take infinite pains to be extremely organized. Be prepared. There are three reasons conscientious people tend to stay healthier and live longer. The first, and perhaps most obvious, is that conscientious people do more things to protect their health. They engage in fewer risky activities like smoking, drinking to excess, abusing drugs, or driving too fast.17 The second, and not obvious, reason for the health benefits of conscientiousness is that some people actually seem to be biologically predisposed both to have that personality trait and to be healthier. They are less prone to a whole host of diseases, not just those caused by dangerous habits. It appears likely that conscientious and unconscientious people have different levels of certain chemicals in their brains, including serotonin, which may be involved. The third and most intriguing reason they live longer is that having a conscientious personality leads people into healthier situations and relationships. They

17

The Longevity Project, (accessed April 23, 2011); available from http://www.theatlantic.com/life/archive/2011/03/the-longevity-project-decades-of-data-reveal-paths-tolong-life/72290/

find their way to happier marriages, better friendships, and healthier work environments. And these things, we found, were key for longer life.18 I am a believer in constant education. I believe in getting to all sides of an idea. The world of theology as regards apologetics, and intelligent design is in constant turmoil and battle. It is essential to keep up with the front edge of these fields as they are like never ending debates with each side countering a previous argument with a new counterargument. Now that such discussion is on the Internet, the flow of ideas is fantastic.19 My practice is to evaluate my situation constantly, and following the advice of the former President Johnson, cut your losses quickly.20 I also believe in beginning almost all relationships in a formal and distant manner, so as to establish respect and autonomy. Then, as the relationship develops, I have an opportunity to warm up. When Bobby Knight the basketball coach actually taught a class, he would ask students to name the toughest teacher they ever had. Then he asked them to name the best teacher they ever had. The result was often that the same teacher was both tough and excellent.21 I ask my employees for hard work, always. My employees are under constant evaluation and feedback. I am always interested in who actually did the work on a project, and who made mistakes. It is very important that folks get credit where credit is due.

18 19

Ibid.(accessed) A local vet and his father had a large animal practice. I hinted that perhaps the father had gotten a little old to practice. His son explained that his dad was the sharpest vet in the group. He was too old to drive, so he was chauffeured from cow to horse, all the while reading the newest Vet journals. 20 Quote from President Johnson, (accessed April 29, 2011); available from http://www.uniteherelocal54.com/data.php? s_id=15436&appid=db15026&action=view&id=16574&how_many_fields=1 21 Bobby Knight and Bob Hammel, Knight : My Story, 1st St. Martin's Griffin ed. (New York: Thomas Dunne Books/St. Martin's Press, 2003), 117.

I always expect a fair paycheck, and when possible, payment received and given as quickly as possible. Many issues and problems come from a financial sloppiness that tends to reflect a failed budget. Unlike the advice given in James to limit hours, I believe a long work week is essential. We all accomplish much less than our forefathers did when our country was very young. We work less than most folks do a century ago. Other cultures have retained their long work hours and prospered. Japanese and Chinese children often have schooldays that extend from 7 a.m. to 9 p.m. (this is a somewhat unfair measure as there is a two hour break for lunch and a two hour break for dinner, but even so, their remarkable success speaks for itself. I believe in maintaining long term relationships and celebrating or remembering the anniversaries of significant events. This keeps relationships with clients from becoming an assembly line. It requires some diligence with communication software, but is not so complicated.
My Plan to Avoid Compassion Fatigue Burnout Family

My family knows that I believe in total generosity. If they need something from me, and ask, if I can do it, I will do it. I do not believe in limited generosity. All of the great pastors I have heard have had the same start in life, a warm and generous mother. I am also a believer in a total dedication to the missions and tasks of my family. I dont read their minds. I ask, explicitly what can I do to help them, often enough so they believe me. Now, I am no sucker, and if I feel someone has some changes to make, I speak with frank honesty. But, my family knows that they have my complete loyalty and acceptance. If I need to speak with a family member, I do it privately, soberly, and

thoughtfully, asking for forgiveness, and expecting to fix any problems. I usually send a short memo to summarize problems and agreements. My health is OK, except as a result of recovery from Cancer, I have very little lung capacity. I get plenty of sleep and try to avoid chair disease.
My Plan to Avoid Compassion Fatigue Burnout - Faith

My most significant plan to avoid burnout is to remember we are all sinners, and need to keep our faith alive to be able to accept the grace of Jesus Christ. I am a very regular and active member of my church, and I have a daily devotion, so Christ is never very far from my heart. CONCLUSION I have examined compassion fatigue, including its components and effects, and considered how I can determine if I have such burnout, and how to avoid it.

BIBLIOGRAPHY