The Practice of Self-Care and the Prevention of Compassion Fatigue

As mentioned earlier, the prevention of compassion fatigue is best tackled at three levels:

Organisational, Professional, and Personal. Things like adequate supervision, good debriefing policy and processes, an organisational culture that allows for open communication and respect, so that when workers say “I’m not coping”, it is seen as a strength rather than a weakness - are all factors in the working environment that support workers’ own self-care. Below, however, the focus will be on what we as practitioners can do for ourselves both personally and professionally so that you can optimise the significant (but not unlimited) resource that is you. These things have been summarised in the literature as the ABCs of Compassion Fatigue Prevention.

A is for Awareness

While this doesn’t sound like a very active strategy, developing a strong self-awareness – an understanding of our physical and psychological reactions to our environment - is one of the most useful resources in helping us act early to prevent any effects of compassion fatigue.

Awareness includes the following:

Personal

Body awareness – the capacity to ‘tune into’ our own nervous system arousal levels, and the emotions associated with these. One Well-known therapists including Charles Figley and Babette Rothschild are renowned for promoting the need to address the impact of the work on helping professionals.
Knowing our own unique responses to stress - these may be behavioural, emotional, cognitive, spiritual or a combination. How do you know when you are stressed? Are you the first to know, or not?
An understanding of the reciprocal impact of work and personal issues – being conscious of what we bring to the work, and of the way in which our reactions to clients can be significantly impacted by what has happened or is happening in our own lives.
Paying attention to personal and relationship issues – it can be easy to neglect ourselves and our personal relationships when we are working hard with troubled clients, yet this is also when we most need to nurture these.
Tapping into our ‘default’ self-talk – are you more likely to hear a critical voice, or an encouraging voice when you listen to yourself? How do you manage your own stress inside your head? What do you default to?
Knowing our own resources and limitations – what is your own ‘psychological job description’? What expectations do you have of yourself? Is it okay to say “I’m not coping!”? Do you know when you need help? Are you able to seek it out?

Professional

Being conscious of our relationship to work – how do you feel about going to work first thing on a Monday morning? Has this changed over time?
Considering which aspects of your work role are energy-draining and which are energising, and thinking about what is possible to increase the latter.
Reflecting on the level of support (and challenge) you receive in your work – do you have access to good quality supervision?
Taking an active role in your own professional development – active, engaged learning is really good for us. Think what input you might need to keep your work refreshed.
Being mindful of your responses to clients. Are there particular people, situations, issues that you work with that tend to make you anxious, bored, restless, tired, etc? Attending to your own nervous system response to particular clients (particularly if it is out of the ordinary for you) can be a really useful prompt for trying something different and avoiding compassion fatigue. Babette Rothschild has many suggestions about this.

Organisational

Organisations need to be aware of the reality of Compassion Fatigue. It is a great start if organisations acknowledge the impact of trauma on the individual worker and on the organisation.
An organisational culture which accepts that this is a ‘side-effect’ of working with traumatised clients and not an inadequacy for particular staff is much more likely to take some responsibility for the well-being of their staff, and in turn, retain staff members over time.
Supervisors, Managers and Team Leaders need to develop an understanding of Compassion Fatigue and an awareness of its likely impact on staff.
Trauma-specific education for all staff also diminishes the potential for Compassion Fatigue. It helps workers to locate their experience, normalise it, and provides a framework or understanding and responding to it. Particular attention needs to be paid to the orientation of new staff, and of any students on placement, who are expected to work with highly distressed clients.
Agencies have a duty to warn applicants of the potential risks of trauma work and to assess individual and environmental factors supporting or challenging resilience.
Developing policy and practice which supports line-managers and clinical supervisors in incorporating discussions of the impact of the work and self-care routinely. There are a number of tools to assess compassion satisfaction and fatigue which supervisors would be well advised to become familiar with, use themselves, and incorporate into their supervision of staff.

B is for Balance

Personal

This covers anything that supports a healthy boundary between work and home, and that provides input to 'charge your batteries'. It pays attention to the ratio of time and energy we spend doing whatever is important in our lives. For instance, it may involve different aspects of our functioning:

Mental - The art of encouraging rather than discouraging ourselves, and finding a balance between support and challenge in our own self-management.
Physical - Sufficient rest and exercise.
Recreational - not only holidays, but some form of regular pursuit that gives us pleasure. In particular, it is said that some form of active, engaged learning is very good for us. Nurture yourself by putting activities in your schedule that are sources of pleasure, joy and diversion. Allow yourself to take mini-escapes- these relieve the intensity of your work.
Emotional - laughter is not only essential for our psychological health, but good for us physically as well. Just as anxiety and distress can be 'contagious', so can laughter. One pioneer in laughter research, William Fry, claimed it took ten minutes on a rowing machine for his heart rate to reach the level it would after just one minute of hearty laughter. Laughter is a powerful antidote to stress, pain, and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh.
Social - Evidence is accumulating to show that healthy relationships provide one of the greatest protective factors against emotional problems.
Spiritual - Transform the negative impact of your work. Think about what energises you, and what has meaning for you in your work and in life. What can you control, and what is out of your control? Acknowledge your own loss and grief, and re-connect with your own values.

Professional

Paying attention to your caseload is important - both the amount of client work, and the diversity. Sometimes workers tend to ‘specialise’ in a particular are of work, and can find themselves working exclusively with a high level of complexity, distress and crisis. Having a diverse caseload helps prevent Compassion Fatigue.
Participating in different areas of work can help. When possible, engaging in research, education, community development or other activities can provide a sense of balance and perspective with client work.
In supervision, balancing discussion of client work with your own development as a professional and keeping your longer-term goals in mind.
Find ways to celebrate the ‘Joys of Practice’ as well as the challenges. To watch clients find their way through the worst pain and adversity, to have (even a small) success in our work – all need to be witnessed and celebrated. Talking to colleagues, or better still – having some ritual within the working week (for example, a ‘Good News’ story section in staff meetings) – whatever brings this part of our work into focus helps all of us to get back in touch with why we do this work, and increases compassion satisfaction.

Organisational

Paying attention to the environment, and modelling the importance of the personal in the professional. A safe, comfortable and private work environment is crucial for anyone who might be exposed to violence. But beyond this – clients give us feedback constantly about the ‘message’ inherent in the environment: a warm, cheery, waiting room with inspiring pictures rather than agency rules on the walls, as well as friendly reception staff who greet clients and call them by name is an ‘investment’ in the client’s relationship with the organisation . Similarly, an organisation which allows for workers to have a work space which they can ‘make their own’ and imbue with what is important to them personally is much more likely to instil a sense of balance. For example, some workers report using particular pictures (of family or nature, or a symbol) when dealing with particularly distressing calls. Further, a space for staff to relax and have ‘time-out’ is ideal: a room with comfortable furniture, a healing garden, a library, or just a quiet corner.
Having line-managers and supervisors work with staff toward a balanced and manageable case-load. The organisation sets the expectations about how workers will experience trauma and deal with it, both professionally and personally. A culture which holds staff well-being as its greatest resource will be vigilant about the impact of the work on individual staff members, and empower managers to take leadership in ensuring that case-loads are monitored, not just in terms of meeting targets, but also in terms of staff members’ experience of the impact of that work on them. While AOD organisations already specialise in a particular area of work, balance can still be achieved by looking at a the impact of the various client work on the worker and having collaborative conversations about the amount of risk, complexity, and burden with various cases.
Providing when possible for a variety of work-roles. Having the capacity to change roles from time to time enhances sustainability. All too often, this happens at higher levels but not at the direct service level of organisations. Further, some jobs have extremely high staff turnover rates for good reasons, but if the ‘Use-By Date’ of such positions is not acknowledged, it can lead to high costs in terms of workers’ feelings of incompetence, or of the position becoming notorious and impossible to fill. Much better to create time-limited contracts for such positions, and rotate staff through them, balancing it over time with different roles.
Promoting supervisory relationships where staff members feel safe to express fears, concerns, and inadequacies as well as inspiration and joy in the work. It is not uncommon for trauma work to leave workers feeling powerless and inadequate. It can lead to ‘crises of confidence’. If these feelings can’t be expressed and normalised without fear of judgement, they put the worker at high risk for compassion fatigue. Managers and supervisors play a strong role in implementing the cultural norms in this regard, and Executive staff members play a strong role in leading and supporting them in doing this.

C is for Connection

Personal

Not only is it important to attend to our mental and physical well-being - we also need to 'feed our souls'. We will all do this in different ways. We need to connect to:

Ourselves - This may be through reflection or more formal meditation. There is good evidence from brain studies about the positive impacts of some form of regular meditative practice.
Others - Nurturing positive intimate relationships, and being part of a community, whether it be through participation in sport, dance, song, or a particular hobby or interest. Pets are also great supports, are good at tuning into feelings, and never argue back!
Something larger - This refers to doing more of whatever it is for you that is good for you, as well as being open to new spiritual explorations, which may involve prayer, meditation, working for a cause, or may be about seeking out particular activities or environments that provide you with a sense of perspective, and remind you of your values and priorities.

Professional

Even at work, staying in touch with what ‘feeds the soul’, whether this be music, a sense of the absurd, going for a walk at lunchtime, connecting with colleagues by celebrating birthdays, etc.
Talking with clients about what is important to their spirits, and what they give value to, whatever this may be. A study done some years ago in Broken Hill investigated what clients in a psychiatric service talked about with their workers, and what they had wanted to talk about but didn’t. 79% rated spirituality as very important, and 82% thought their therapists should be aware of their spiritual beliefs and needs. 67% said that their spirituality helped them cope with their psychological pain (D’Souza, 2002). This led the author’s team to develop a “spiritually augmented” treatment approach. The issue of spirituality may be particularly relevant to certain cultural groups, not least our own Aboriginal and Torres Strait Islander clients. Not only the work is enriched by incorporating what inspires and has meaning for our clients’ lives, but so are we as workers .
Nurturing relationships with colleagues. Peer supervision, co-work, and team- work can all help mitigate the potential negative effects of the work. In particular, team-work is one of the best antidotes to compassion fatigue. Team dinners, attending professional development activities together, having lunch together, planning new ventures in the work all help to reduce isolation and combat compassion fatigue. Further, sharing some non-work resources like books and music can enhance connection and working relationships.

Organisational

Remaining open to the inclusion of spirituality in the work and in the workplace. Is there a place for music, conversations, meditative practice, even pets in the workplace?
Making resources available for connection and self-care. This might include access to counselling services, peer support groups, good critical incident debriefing, lunchtime walking or meditation groups, or access to positive well-being programs like yoga, massage, self-defence, Tai Chi, subsidised gym memberships, etc. Just as most agencies make available PD allowances for staff, it would be a great investment in morale and staff retention to institute a Well-being allowance!
Developing a values-based organisational culture which holds care for each other as a basic requirement. This goes beyond the usual ‘Mission Statements’ that most agencies print for clients and which does nothing more than sit on a waiting room wall. It means taking a position of ‘Ethical Maturity ’ (Carroll & Shaw, 2014) and constantly being vigilant to ways of living a set of values in the work that is developed collaboratively with all staff. When an organisation connects with its own values, workers are much less likely to suffer from isolation, fear of judgment, and the negative consequences that can come about from having personal knowledge of oppression, abuse, violence, and injustice.
Seeing leave, time-out, and sabbatical breaks as an investment in staff members' sustainability in the work, and an opportunity for them to refresh themselves and the work. Even Mother Teresa acknowledged the impact of the work: she made it mandatory for her nuns to take a ‘sabbatical’ year off from their duties every 4-5 years to allow them time to heal from the effects of their care-giving work!