The cost of caring; vicarious trauma, compassion fatigue, burn out

Imaginif talk doctors are not alone in the heavy, gut wrenching, emotionally taxing work that we do. Many of you, other workers, foster carers, parents, friends, find yourself in a similar position. Listening to and working with people’s pain can eat away at our souls if we do not have protective strategies in place to prevent compassion fatigue. This is the cost of caring.

Working therapeutically with adults is difficult enough; working with children abused by adults is more challenging. Yet, day after day, thousands of social workers, psychologists, teachers, caseworkers, police officers, judges, pediatricians and child mental health professionals work with and try to help abused children. And each year, parents, grandparents, foster and adoptive parents care for these children. That is a lot of trauma going around and around and around.

For those working with abused children in particular, the trauma we witness in them is not benign in our own bodies and minds. The effects of the abuse that we work with become a secondary trauma: a malignancy to us working with abused children. Just as trauma damages children, the secondary trauma can result in serious and chronic emotional and behavioral problems, in workers, helpers and carers. This secondary trauma can be difficult to treat because so few people are willing to recognise it and do something about it. Prevention of secondary trauma; vicarious trauma, compassion fatigue, burn out, is a must when working with children who have been abused.

The reality is that withn our work lives there are insufficient help resources to go around and working within over stretched systems can be very difficult. Add multiple children presenting with a host of serious problems and those caring for the children can become confused, overwhelmed, stressed and burnt out. The pain and helplessness of the children can be passed on to those around them. Listening to children talk about the trauma, trying to work in a complicated, frustrating and often “insensitive” system, feeling helpless when trying to heal these children – all can make the adults working with these children vulnerable to developing emotional or behavioral problems: vicarious trauma, the cost of caring.

How to prevent vicarious trauma (compassion fatigue):

• Understanding and responding to your own needs is the essence of an effective self-care strategy. Learning to balance work and play is an important place to begin. Those who work in stressful helping environments often find it difficult to leave work at the office when it is time to go home. This may include replaying situations or conversations over in their head or continuing to mentally work through issues even when the paperwork is left behind. Clearly setting boundaries of “their time” and “my time” is an important step to regaining control over your life. Creating time for rest and leisure is part of this. Finding activities that focus your mind and body elsewhere, such as reading, bush walking, sports, gardening, or playing with children, aid in clearly separating work time from leisure.
• Maintain a positive view of the world: When working with clients who have experienced trauma, it may become easy to believe that the world is falling apart or that people are going mad. The world is not falling apart everywhere and not everyone is mad. Remember that, although bad things happen and people are affected, there is a lot of good that goes on as well. Work to look for the good in people and situations. Remember the good you are doing.
• Use workplace supervision (or friend/peer debriefing) in a way that suits you. Talking about what you are feeling and how your work is affecting you not only provides an outlet for your feelings but may also allow your supervisor to understand your needs and likely your fellow caseworkers needs as well. Your supervisor/friend may be able to help you find ways of handling work related stress.
• Stay engaged with people you like. Talk, talk, talk to your own support networks. One thing that we know about trauma is that talking about it helps to reduce its effects.

Steps for Combating Caring Stress

Stand back and reflect. Ask yourself:

1. Does this really matter? There are times when caring is so stressful that it becomes overwhelming and paralyzing. Ask yourself, “Does this [situation/occurrence/task] really matter.” This question will help you sort priorities: what is important and what you can let go of.
2. Have you done the best you can under the circumstances? It is easy to become obsessed with what we might, should, or could have done. Focusing on doing good work and learning from mistakes is an important part of growing as a professional. If you have done the best you could with the information you had to work with, let it go and move on to the next thing.
3. Do you have realistic expectations of yourself and others? Often times helping professionals have unrealistically high expectations of themselves and those around them. You can’t be with your clients 24 hours a day, 7 days a week. You can’t make decisions for them or help them carry out those decisions. Consider the two competing pressures that are part of your job: In one respect, you are expected to be empathic (which requires you to take feelings into consideration), yet on the other hand, you are expected to turn off emotions in order to get a great deal of work done. Knowing that these two expectations are part of your job may help you find a balance. Create reasonable, achievable goals and expectations for yourself and others and see how much better you feel about meeting your expectations!

Engage in Healthy/Healing Activities

Engaging in activities that are good for you is essential. You are in control of how you treat yourself. The list below includes things you have heard before and inherently know, but as “helpers” we often forget.

• Eat right. Put down the bag of chips and pick up an apple. Drink less caffeine and more water.
• Exercise regularly. Exercise is a stress reliever. Even if the only exercise you have time for is walking around the parking lot at lunch – try it. You will be amazed at how much better it makes you feel. (It also gets you out of the office, away from the computer, fax, etc.)
• Get enough sleep. Your body needs sleep to recover so that you are better able to handle the stress of a new day.
• Practice relaxation techniques. You know them – deep breathing, visual imagery. We often help our clients find ways to relax. Believe it or not, they’ll work for you too!
• Spend time with friends. “A true friend is someone who is there for you when they would rather be someplace else”, Len Wein. Being with people you like and who care about and respect you is a great stress reliever. Allow yourself to enjoy the company of others instead of focusing only on work and work issues.

Re-engage in Work Activities

Incorporating ways of managing stress into your daily routine will go a long way to making work seem more manageable. There are several ways that you can help yourself re-engage in work activities in a less stressful way.

• First, work to set manageable tasks for yourself. Completing tasks will reduce stress.
• Second, find a pace that works well for you. Some people work better under a deadline while others work better at a slower but well-maintained pace.
• Third, organize your time and activities. Set reasonable goals for yourself and organize your time based on what you need to accomplish in a given day. Be careful not to over-schedule or make long to-do lists that are unreasonable and will only add stress.
• Finally, help someone else. Helping others makes you feel good about yourself. Relationships are an important part of life – rely on them. Giving them up so you can work more deprives yourself of a major stress reliever.

Be the change you want,
hero day June 13

Thanks to the Child Trauma Academy for some of the ideas in this article.
Special thanks to Hannah from James Cook University for reminding me to get this article on the site.