Treating compassion fatigue

Treating compassion fatigue

Kluft, Richard P

Figley, C.R. (2002, Ed.)· Treating compassion fatigue. New York: Brunner-Routledge. $60.95 (227 pages) Reviewed by: Richard P. Kluft, MD, PhD, BaIa Cynwyd, PA.

Treating Compassion Fatigue is one of the more recent volumes in the distinguished Brunner-Routledge Psychosocial Stress series, under the overall editorship of Charles R. Figley, Ph.D. It follows and builds upon the 1995 Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized in expanding our knowledge of this phenomenon and its management. Compassion fatigue is the convergence of traumatic stress, secondary traumatic stress, and cumulative stress and burnout (Gentry, Baranowsky, & Dunning, p. 124, this volume). It is a broader concept than any of the phenomena subsumed within it, or countertransference. Furthermore, although it can be applied to the situation of an individual therapist working with the traumatized, it is employed as well to describe the reactions of helpers of all sorts responding to disasters, such as the Oklahoma City bombing, 9-11, and the terrible war in the former Yugoslavia.

In Treating Compassion Fatigue, American, Australian, and Canadian mental health professionals explore a wide range of topics in two main sections. The first five chapters develop the conceptual complexity of compassion fatigue with both theoretical and research-driven contributions. The second five chapters discuss innovations in treatment and prevention.

Valent’s chapter develops a model of helper responses and pathologies with eight survival strategies (rescuing, attaching, asserting, adapting, fighting, fleeing, competing, and cooperating) and describes their successful and unsuccessful biological, psychological, and social dimensions and manifestations. The way victims’ and helpers’ survival strategies evoke responses in the others are considered. While complex and at times arbitrary, this model has much to offer for future study. Meyers and Cornille’s study of the impact of secondary posttraumatic stress upon child protective services workers demonstrates the perils of doing this demanding kind of work. Wee and Myers studied those who provided service in the Oklahoma City bombing. Administrators suffered more stress than direct providers, and duration of service correlated with severity of symptoms. Meldrum, King, and Spooner studied Australian case managers, and found that a large proportion developed some symptoms of posttraumatic stress, and about one in five had symptoms consistent with a diagnosable PTSD. Stamm studied the phenomenon of compassion satisfaction, which may facilitate the understanding of why some workers may be more resilient than others.

Gentry, Baranowsky, and Dunning describe the Accelerated Recovery Program for compassion fatigue, a five-session treatment protocol for distressed helpers. This involves helping the helpers identify, understand, and develop a hierarchy of what triggers the symptoms of compassion fatigue; helps practitioners review their present methodologies for addressing their difficulties, and develop plans for self-treatment; helps practitioners to identify resources for addressing compassion fatigue; teaches effective self-soothing; teaches grounding and containment skills; helps them acquire proficiency in self-care, boundary-setting, and skills acquisition; teaches the technique of video dialog for internal conflict resolution and self-supervision; and facilitates the development of a self-administered self-care plan. Moran studies the role of humor in coping with life Stressors. Baranowsky illuminates the silencing response, in which assumptions are made such that the clinician guides the client to redirect, shut down, minimize, or neglect the trauma and related concerns. White discusses compassion fatigue in connection with a training program in the use of eye movement desensitization and reprocessing (EMDR) in war-torn Yugoslavia. Finally, Myers and Wee review their study of responders to the Oklahoma City bombing disaster, and suggest strategies to help traumatologists before, during, and after disaster assignments. Their synthesis is thoughtful and worthy of study by anyone with administrative responsibility for helpers vulnerable to secondary PTSD and compassion fatigue.

Treating Compassion Fatigue is more a series of intellectual snapshots of a field in the process of becoming than a definitive statement about the important topics it addresses. It will be of more use to those who are deeply involved in the trauma and disaster relief fields and need information as it develops than to those who seek a definitive synthesis. This is a book which is more useful for administrators and planners than for front-line clinicians. It outlines the problems that first responders, other helpers, administrators, and case managers are likely to encounter when they deal with the traumatized, and offers some tentative and partial solutions. It should be helpful in informing efforts to develop and build in interventions to “help the helpers” in agencies that deal with trauma in general as well as those that deal with disasters.

However, the individual clinician will probably learn the most from the Valent’s chapter on survival strategies, Moran’s study of how helpers use humor to cope, Baranowsky’s informative exploration of the silencing response, and Gentry, Baranowsky, and Dunning’s suggestions for the self-treatment of compassion fatigue.

Hypnosis plays no significant role in Treating Compassion Fatigue, a glaring indication that traumatologists in general have not yet appreciated the powerful role hypnosis can play in facilitating many of the types of interventions that are recommended to assist those with compassion fatigue. Hopefully this omission will be rectified as the study of compassion fatigue and its treatment comes of age.

Taken and understood on its own terms, Treating Compassion Fatigue is a valuable contribution to a field of study that is in its early stages of evolution. Notwithstanding its virtues, numerous minor inaccuracies, jarring dysfluencies, and problems in copy-editing compromise the book. For example, a five-chapter section is described as having six chapters, superfluous words appear in otherwise fluent sentences, and some sentences and paragraphs cry out for rewriting. In one instance, a strong correlation is reported between the abbreviation of a concept and that very concept spelled out completely (CF is highly correlated with compassion fatigue).

References

Figley, C.R. (Ed.) (1995). Compassion fatigue: Coping with secondary posttraumatic stress disorder in those who treat the traumatized. New York: Brunner: Mazel.

Reviewed by: Richard P. Kluft, MD, PhD, Bala Cynwyd, PA.

Copyright American Society of Clinical Hypnosis Oct 2004

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