Shortly after I joined the Center for Deployment Psychology (CDP), I was asked to be part of a working group to develop a course on provider sustainment, also known more widely as provider self-care. Although, we did not at the time offer a standalone lecture on the topic, the importance of taking care of oneself was highlighted in many of our existing courses. As our working group began to review the literature, we reflected on and discussed our own experiences with provider self-care in different clinical settings. For myself, working in a maximum security prison first as a psych associate and later as a staff psychologist, self-care was essential.
What did I do to take care of myself? Well, I did my best to not self-isolate. This was difficult given that I had a high case load and long days. Like many clinicians, I jumped from one individual session to the next and from one group to the other. Case conferences, intakes, assessments, and meetings filled the remaining hours. A colleague of mine and I agreed to leave the institution at minimum two times per week for lunch. This was not an easy process with having to go through metal detectors and pat downs in and out of the facility, but one that most likely had a positive impact on our mental health. I also decided that no matter how busy my day, I would take 15 minutes to leave my desk (and go to the common office area) and have a cup of coffee. Something as small as leaving my window open during good weather, helped me take a few breaths and take a moment for myself to regroup. I took on calligraphy as a hobby and a few yoga classes. Lastly, I stopped watching movies and television shows that were based on prisons. These are a few examples that came to mind when I reflected back to how I took care of myself. I wonder if these things I practiced helped me from feeling burned out or experiencing compassion fatigue.
Mental health providers, whether in large community mental health centers, prisons, small private practices, or even in deployed military settings are at risk for compassion fatigue or burnout. All are nurturers who hear many stories about traumatizing events.
For the purpose of this blog, I would like to highlight an article that is in press by Owen and Wanzer (2013). They set out to define compassion fatigue in military healthcare teams. The group included Active Duty, National Guard, or Reserve physicians, nurses, medics, chaplains, social workers, and psychologists serving in the military or public health that provided care supporting casualties of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Although Figley (1995) has defined compassion fatigue as emotions and behaviors resulting from having knowledge about another’s traumatic event, Owen and Wanzer found that there was no one consistent way of defining compassion fatigue.
Through their analysis of the literature, they found seven main themes that examined the meaning of compassion fatigue. The top two themes identified were (1) occupational hazard and (2) psychological distress. The remainder of the themes were a sense of helplessness, fear, loss of purpose, inability to recognize own needs, and empathy. They also grouped the themes in accordance with the Bandura Social Cognitive Theory (SCT) model. The SCT model has three components, behavior, personal, and environment, noting that change in one component impacts the other. For example, occupational hazard can be an example of the environment whereas sense of helplessness can be a personal factor. The article is a nice conceptual framework for defining compassion fatigue. As noted by the authors, once we have a more clear definition of compassion fatigue the more we can become aware of prevention, risk factors, and interventions. I would recommend this article to anyone in the healthcare team. Ultimately, caring for caregivers although it may sound cliché, is vital.
Dr. Diana Sermanian is the Assistant Director for Civilian Programs as the CDP. In this role, she oversees many of the training programs the CDP presents for behavioral health providers.
Article: “Compassion Fatigue in Military Healthcare Teams” (Article in Press)
Reference: Owen, R.P., & Wanzer, L., Compassion Fatigue in Military Healthcare Teams, Archives of Psychiatric Nursing (2013), http://dx.doi.org/10.1016/j.apnu.2013.09.007
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Bristol, PA: Brunner/Mazel.