Barbara Rubel, MA, BCETS 1

Transcription

1 Providing Compassionate Care Without Experiencing Compassion Fatigue 2017 Communities in Action to Prevent Suicide Annual Conference April 19, :15pm 2:30pm Barbara Rubel, MA, BCETS, CBS 1 As a Thanatologist, I m a specialist in the dying and grieving process, social attitudes toward death, ritual and memorialization, non-death related loss, and the social and psychological aspects of traumatic death, dying, and bereavement. Reasons to live Reasons to die Barbara Rubel, MA, BCETS 1

2 Overall Learning Goal Professionals will recognize those things that influence the way individuals grieve after a suicide, how those factors can have an effect on them, as professionals, and how to use their strengths to cope with job burnout, compassion fatigue, and vicarious trauma. Objectives 1. Identify contributors to burnout syndrome, compassion fatigue, and vicarious trauma 2. Identify ways to put character strengths into practice to develop resiliency 3. Describe eight self-care techniques to mitigate the impact of vicarious trauma Determinants of Grief Factors that influence the grief process Determinants of grief indirectly expose you to traumatic material For example: Type: what caused person to die...suicide Barbara Rubel, MA, BCETS 2

3 Determinants of Grief Manner: (natural/unnatural; accidental (unplanned); suicide (intentional) or homicide Sudden: unanticipated/anticipated; natural/unnatural Preventable/Avoidable: blame, culpability can develop (firearm, bullycide, substance misuse) Traumatic: overwhelming; intense fear, distress, anxiety; trauma exposure (voic ) Determinants of Grief Ambiguous:alive, dying (Boss, 2006) Responsibility/Accountability: hastens death Psychological Proximity:dependency; relationship; neg./pos. feelings (loved/hated) Attachment: mourn due to perceived emotional closeness to person that died Determinants of Grief Age: deceased/mourner Historical Background Coping Style: Positive: solutions through problem engagement; reframe; faith/spirituality; humor; social support or Avoidance: blame; denial; and self-medicate Barbara Rubel, MA, BCETS 3

4 Determinants of Grief Grief Style: Intuitive/Instrumental/blended (Martin and Doka, 2001) Gender: more similar than different Psychiatric Issues: mental illness, alcohol abuse; obsessive compulsive disorder; PTSD Stability: secure, reliable, established, dependable; social/financial position Determinants of Grief Religion & Spirituality: belief systems/practices Ethnicity: traditions and customs retained by group with same racial background Culture: shared values, practices structure behaviors and way to act ntimeliness Deceased has yet to meet full potential Suicide one week before graduating from H.S. Died right before becoming a grandpa Barbara Rubel, MA, BCETS 4

5 Disenfranchised Grief Loss is not or cannot be openly acknowledged, publicly mourned or socially supported (Doka, 2002) Your dad committed su-i-cide? What a selfish thing for him to do! Didn t you talk to him or see the signs? Tabooed Topics Now I ll never get the mom I always wanted to have. Dad was suffering for so long finally, I m free! What if my other child kills himself, too? Presence or Absence of Suicide Notes Type: Written, Facebook, Twitter, text, video Range: Not meaningful/helpful to monumental importance Notes help cognitively process experience Leaves more questions than answers Revelations can help shorten bereavement Cerel, J., Moore, M., Brown, M.M., Van De Venne, J, and Brown, S.L. (2014). Who leaves suicide notes? A six-year population-based study. Suicide and Life- Threatening Behavior 45(3) Barbara Rubel, MA, BCETS 5

6 Determinants of Grief Multiple Losses: saturation point; surge of feelings when prioritizing grief Secondary Loss: economic; routines; never going to be parent or grandparent Concurrent Stressors: self-induced; environmental; relational; job; physical; and mental stressors Compassion Fatigue Negative aspect of helping those who experience traumatic stress and suffering Not a diagnosis Overwhelmed by caring Stamm, 2010 Contributors to Compassion Fatigue Boundary issues Inadequate job training Too many, difficult, new, or unusual cases High empathy (Ster, Ster, Peteck, & Gorup, 2013) Haven t worked through personal loss/trauma Lack of self-care and reflection after being fully present with survivor s suffering Barbara Rubel, MA, BCETS 6

7 Two Parts of Compassion Fatigue 1. Burnout 2. Secondary Traumatic Stress (STS) Stamm, 2010 Part 1: Burnout Gradually become negative Cynical, hopeless, exhausted, angry, frustrated, overwhelmed Workplace: unmotivated, actively disengaged, uninvolved, unhappy and act out unhappiness Not effective and distressed at work Stamm, 2010 Contributors to Burnout Occupational stress; heavy caseload Huge consequences for failure Non-engagement (satisfied; not connected) Not good fit (strengths/skills don t match job) Compensation Poor leadership (unfairly treated, ideas aren t appreciated) Barbara Rubel, MA, BCETS 7

8 Part 2: Secondary Traumatic Stress When caring for traumatized persons is due to: Work related direct/primary Indirect/secondary trauma exposure Negative feelings and possible PTSD symptoms are driven by fear and exposure Stamm, 2010 Contributors to Secondary Traumatic Stress Broad spectrum of distress resembles PTSD Transferred from victim/survivor to helper Exposed to pain and suffering of others High empathy: identify with and understand what survivors are going through Klaric, M. Kvisic, A. Mandic, V. Petrov, B. & Franciskovic, T. (2013) Secondary traumatization and systemtictraumatic stress. Medicina Academica Mostariensia, 1(1), Vicarious Trauma Exposed to vivid and graphic images of survivor s traumatic material Cognitive changes (e.g. safety, trust, esteem, intimacy, control) in inner experience after exposure Less about trauma symptoms Moreabout cognitive symptoms (safety, trust, control) Barbara Rubel, MA, BCETS 8

9 Contributors to Vicarious Trauma Cumulative effect of frequently being empathetic, committed, and responsible to help while hearing trauma related narratives Personal history of trauma (Iqbal, 2015) Ways of coping Professional isolation Eight elements of resilience form acronym The FABLOS Principle (F)lexibility (A)ttitude (B)oundaries ()nderstand job satisfaction (L)aughter (O)ptimism ()nited (S)elf-compassion The FABLOS Principle Protective factors prevent compassion fatigue Put character strengths into practice to build resilience Self-help strategies Eight characteristics of resilience Rubel, B. (2016). Death, Dying, and Bereavement: Providing compassion during a time of need (3 rd. Ed.). MA: Western Schools. Barbara Rubel, MA, BCETS 9

10 Flexibility A B L O S Do You Have a Resilient Mindset? Cope with disturbing change See range of possible consequences Shift thoughts in any situation It s okay to change your mind 29 A Resilient Mindset Do you know your vulnerable point? Do you have the capacity to stretch to the point of resistance? 30 Barbara Rubel, MA, BCETS 10

11 Character Strengths Put strengths into practice to be flexible Curious: explore, discover Creative: imaginative, clever Love of learning: enjoy learning new things Which quality most defines you? F Attitude B L O S Negative, neutral, mixed, positive view Outlook based on past circumstances Guides state of mind Framework to solve problems Character Strengths Apply strengths to have a positive attitude Judgment/critical thinking: think things through; change mind Perspective:wise; high level of knowledge; provide counsel Brave: face challenges; speak up for what s right Which quality most defines you? Barbara Rubel, MA, BCETS 11

12 F A Boundaries L O S Boundary: limit of acceptable behavior Boundary Crossing: take files home; accept gift; give client home telephone Boundary Violation: business venture; romantic relationship Professional Boundaries Organizational policy Ongoing ethics training Monitor behavior/self-observe Self-disclosure should be helpful Know the consequences Problems arise in that one has to find a balance between what people need from you and what you need for yourself. Jessye Norman Barbara Rubel, MA, BCETS 12

13 Character Strengths Apply strengths to maintain boundaries Prudence: careful about choices/risks; things may regret Self-Regulation: control/discipline Fair: treat everyone same without bias Which quality most defines you? F A B nderstanding Job Satisfaction L O S 38 nderstanding Job Satisfaction Perceive there is a fit between: 1. Job description (aware of responsibilities; participate in decision-making) 2. Needs (security, trusted leader, supervision, working conditions and culture, paid well) 3. Accomplish goals (decision-making, ongoing education, use skills, make a difference) Keller, A.C. & Semmer, N.K. (2013). Changes in situational & dispositional factors as predictors of job satisfaction. Journal of Vocational Behavior, 83(1), Barbara Rubel, MA, BCETS 13

14 Compassion Satisfaction Pleasure you get from doing your job well Gratification from being kind and considerate Positive perception of coworkers/crisis interv. Meaning making: I have calling in life The Professional Quality of Life Scale (PROQOL) Character Strengths Apply strengths to understand job satisfaction Leadership: encourage group while maintaining good relations Teamwork: work well with group; loyal Appreciation of beauty and excellence: notice and pursue wonder in everyday experiences Which quality most defines you? F A B Laughter O S Barbara Rubel, MA, BCETS 14

15 Why Should You Have a Sense of Humor? 1. Boosts morale 2. Decreases stress 3. Improves communication 4. Encourages group cohesion 5. Enhances creativity and problem-solving What Do You Find Humorous? Stand-up: comics, jokes, stories Slapstick: physical comedy Sarcastic: dark comedy Gallows: grim/misfortune Observational: not planned Self-deprecating: poke fun at yourself Character Strengths Play to your strengths to maintain a sense of humor Playfulness: laugh; light side of things Zest: enthusiastic, feel alive Which quality most defines you? Barbara Rubel, MA, BCETS 15

16 F A B L Optimism S Optimistic Cat I m not getting kicked in the head by the ball. Doesn t assume blame, It s the player s fault for playing so close to me. Gives himself credit, I ve such quick moves. Situation temporary, This soccer player will miss. Pessimistic Cat I m so getting kicked in the head. Shoulders blame, It s allmy fault for hanging out on a field. Situation is constant, I ll neverget off this soccer field. Barbara Rubel, MA, BCETS 16

17 An Optimist and a Pessimist Describe Their Job Optimist: rewarding, fulfilling, gratifying Pessimist: wounding, exhausting, draining Character Strengths Put strengths into practice to be optimistic Perseverance: purpose; completes tasks Hopeful:anticipate best possible outcome and you can bring it about Forgiveness: accept flaws in others; give others second chance Which quality most defines you? F A B L O nited S Value placed on companionship/community Quality of social environment Personal relationships: faith, family, friends Workplace relationships: managers, co-workers, and subordinates Barbara Rubel, MA, BCETS 17

18 Character Strengths Put strengths into practice in order to be united Honesty: present yourself in genuine way Love: value relationships; close to others Social Intelligence: fit in; aware of other person s feelings and motives Which quality most defines you? F A B L O Self-Compassion nconditional loving kindness to yourself as you attend to problems or experience suffering rather than selfcriticism (Neff, 2011) Self-Compassion and Positive Growth Beneficial changes and transformation Re-evaluate goals and shift priorities Value relationships Growth promoting activities Barbara Rubel, MA, BCETS 18

19 Character Strengths Apply strengths to be self-compassionate Spiritual:faith, higher purpose; meaning in universe Humility: just as special as everyone else Kindness: helping, caring for others and self Which quality most defines you? Live Within Your Value System as it Defines Your Character I would like to be remembered for my... Being a good friend Care for my family Honesty Faithfulness Helping others Love of God Hard work Empathy Fairness Generosity Schoenbeck, 2010, The Remembrance Study Meeting Our Objectives 1. Identify contributors to burnout syndrome, compassion fatigue, and vicarious trauma 2. Identify ways to put character strengths into practice to develop resiliency 3. Describe eight self-care techniques to mitigate the impact of vicarious trauma Barbara Rubel, MA, BCETS 19

20 Who are you? said the Caterpillar... I I hardly know, Sir, just at present, Alice replied rather shyly, at least I know who I was when I got up this morning, but I think I must have been changed several times since then Lewis Carroll 58 Perception Grounds for Sculpture "We don't see things as they are, we see them as we are" Anais Nin Grounds for Sculpture Barbara Rubel, MA, BCETS 20