Research Paper By Doukessa Lerias
(Transformational & Motivational Coach, USA)
Compassion fatigue is an inevitable work hazard for care-providers such as; mental health staff, first responders, teachers, and hospital staff. Compassion fatigue is a subtle and gradual deterioration of a care-providers well being. It occurs due to consistent exposure to the traumatic stories and circumstances of the people they serve. This research paper explores the option of transformational coaching as an important avenue for addressing the effects of compassion fatigue. In light of other professional structures that exist to address the work-hazards of care-professions, transformational coaching has been identified as a unique and effective experience. Transformational coaching fosters an in-depth relationship which can directly address a disrupted worldview, the underlying driver of compassion fatigue.
Compassion fatigue is a work hazard experienced by care-providers that are regularly exposed to traumatic stories and experiences of the people that they serve. It is common among mental health clinicians, first responders, teachers, nurses, medical and hospital staff and counselors (Brockhouse, et al., 2011; Howlett & Collins, 2014; Hydon et al., 2015). Vicarious trauma, burnout, or secondary trauma, are other terms for compassion fatigue. Essentially, the consequences of working as a care-provider can cause gradual changes in an individual’s well-being. This includes heightened anxiety, excessive stress and fear, negative changes in worldview, symptoms of depression and physical and mental exhaustion (Branson et al., 2014; Finklestein et al., 2015; Samios, et al., 2012; Zimering et al., 2003). Although there is an emphasis on self-care, professional development and organizational support, as a way of reducing the effects of compassion fatigue, these structures are often not adequate in managing this experience (Brockhouse et al., 2011). Transformational Coaching is a great resource for care-providers, in directly addressing the effects of compassion fatigue. It allows individuals, a safe, comforting and non-judgmental platform to address the personal cost of their work, adopt positive structures and connect successfully with the rest of their life (Sun et al., 2013).
What is compassion fatigue?
Compassion fatigue is almost inevitable among healthcare workers and anyone working in a field that exposes them to stories of trauma and torture by students, clients or patients. It is a gradual process and often individuals learn to adapt to the changes in their mental health, as they can still function on a daily basis and can often maintain occupational success (Howlett & Collins, 2014). However, gradual but definite changes occur that can be similar but milder than posttraumatic stress disorder. Experiences such as avoidance of everyday material that may remind them of trauma (e.g. the news), social withdrawal or disconnectedness from relationships, heightened fear, anxiety and stress, experiences of mild but lingering depression, physical and mental exhaustion (Hydon et al., 2015; Samios et al., 2012; Zimering et al., 2003).
Care-providers work under a unique set of circumstances, that requires them to exercise specific, high-level skills under substantial emotional pressure. This often includes fear, or a sense of threat to their safety, or wellbeing and also challenges their worldview (Abel et al., 2014; Brockhouse et al., 2011). Compassion fatigue can change the manner in which people work. Providers can begin to avoid certain clients and their stories, attempt to rescue or control their clients, violate professional boundaries or experience conflict with their colleagues (Zimering et al., 2003). Zimering, Munroe, and Gulliver (2003) stated “A clinician whose views of trust and safety have been undermined, may be unable to respond effectively to traumatized patients.” (Zimering et al., 2003, pp2). This leaves both the care-provider and their clients vulnerable to further distress. Consequently, compassion fatigue can often lead to a number of personal problems for the care-provider. It can encourage interpersonal difficulties, physical illness, poor motivation, addictions and other poor coping habits (Zimering et al., 2003).
What is typically available to address compassion fatigue?
There is substantial emphasis on self-care as a way to manage the hazards of working as a care-provider. However, the definition of self-care can vary depending on profession, workplace culture, training and resources.
The most common resource that is available is supervision. Peer or professional supervision, has been identified as a tool in professional development. It is a platform for healthcare professionals to discuss the direction and impact of their work. It is an essential part of mental health clinical practice and other care professions have a similar structure. However, the priority of this service varies depending on profession and workplace (Brockhouse et al., 2011).
Organizational culture and a safe organizational space, that addresses safety and wellbeing, has also been identified as increasing job satisfaction in healthcare professionals (Brockhouse et al., 2011). A workplace that is safe, that allows space for the processing of traumatic material, that fosters camaraderie and employee care, effectively supports the delivery of good professional services in the community (Brockhouse et al., 2011).
Professional training and development has also been advocated as a way to better manage clients with traumatic histories or, who are in traumatic situations. The delivery of effective services has been thought have an effect on the sense of self-efficacy and competency of care-professionals (Brockhouse et al., 2011).
However, does this reduce or protect against compassion fatigue? Not exactly. A safe and well organized workplace, access to supervision and training, can often prolong the effects of compassion fatigue and misinform individuals about the personal cost of their job (Brockhouse et al., 2011). An organization that fosters camaraderie, employee care and posttraumatic growth, can address the immediate effects of trauma exposure and alleviate distress for a short time, but does not protect against the effects of compassion fatigue (Brockhouse et al., 2011; Abel et al., 2014; Downey, 2015; Samios et al., 2012). These structures also do not address the change in one’s worldview, changes to relationships or the ability to adapt to normal life, after exposure to traumatic material (Abel et al., 2014). Research on supervision as a protective factor for compassion fatigue does not show significant effects (Abel et al., 2014; Brockhouse et al., 2011; Sun et al., 2013).
Although many care organizations also offer psychological treatment and counseling for their staff, care-providers continue to experience barriers to attending therapy that include; stigma, the inability to show vulnerability and denial of the effects of the work, as well as having to manage large caseloads with continuous exposure to traumatic stories (Brockhouse et al., 2011; Zimering et al., 2003). These barriers can be difficult to shift especially in more experienced staff (Brockhouse et al., 2011). It is commonly recommended that both survivors of trauma, and care-providers, who are vicariously exposed, seek personal growth as a way to heal from the effects of posttraumatic stress and / or secondary traumatization (Downey, 2015). This is commonly achieved through psychological therapy, religion or other forms of healing (Samios et al., 2012). However, although personal growth does reduce feelings of anxiety and experiences of depression, it does not entirely address the effects of compassion fatigue, because it doesn’t improve one’s worldview (Abel et al., 2014).
What is a worldview?
A person’s worldview, is essentially defined as the perception of the world they live in and their beliefs about how it works. A number of factors contribute to one’s worldview that include; individual experiences, philosophies, faith, hope, values and rules about the world. An individual’s worldview often moderates their sense of safety, relationships and what they think about themselves. It contributes to their self-esteem and the manner in which they solve problems. For people who have been exposed to a traumatic event, their sense of safety is catastrophically disrupted, and the world may not make sense to them anymore. Part of adapting to trauma after the event is to begin to develop a new worldview, where that event makes some sense, and the individual has an ideal plan for protecting themselves in the future (Abel et al., 2014). Part of healing from trauma means creating a worldview that despite the event, has a positive connotation and allows the individual some sense of safety and hope (Abel et al., 2014; Brockhouse et al., 2011).
For care-providers who are regularly exposed to the details of someone else’s stories of trauma and violence and, who are focused on healing their client, student or patient, the change in worldview happens subtly, unconsciously and most often is not addressed (Howlett & Collins, 2014). Care-providers can become so invested in protecting themselves and those they serve, that they lose awareness of the changes that have occurred. Especially in the manner in which they respond to the world, in their relationships, their loss of hope and increased perceptions of threat and suspiciousness (Abel et al., 2014).
What is a healthy a worldview? Abel, Walker, Samios and Morozow (2014) conducted research exploring the healing process after exposure to trauma. 126 participants who had been exposed to trauma either directly or indirectly, were assessed using questionnaires addressing the ability for participants to adapt and heal after exposure (posttraumatic growth). Abel et al. (2014) found that although personal growth reduced experiences of depression, the participants’ worldview was key in directly improving the effects of posttraumatic stress. In fact, this was more important than personal growth in healing. Aspects of a healthy worldview after exposure to trauma include at least some of the following beliefs:
- “I can count on people in times of trouble”
- “People are wonderful”
- “I have a sense of self-reliance”
- “I accept that I need others”
- “I have a strong religious faith”
- “I am willing to express emotions”
- “I have a better understanding of spiritual matters”
- “I appreciate the day”
- “I put effort into my relationships”
- “I have a greater appreciation of my own life”
(Cited in Abel et al., 2014, Table 1, pp12)
Can transformational coaching help change a care-provider’s worldview?
It can be assumed that when a care-provider has been working for some time, they have had multiple exposures to traumatic material. Regardless of their level of awareness, their worldview has most likely changed and they are experiencing compassion fatigue (Abel et al., 2014; Samios et al., 2012; Zimering et al., 2003). Care-providers need a safe, non-judgmental platform to address the issues of trauma exposure.
Care-providers may not be suited to formal therapy, which can insinuate incapacity, vulnerability and prescriptive treatment. They are often fearful of stigma, expressing vulnerability and may come from a work culture of denial. Additional barriers to accessing psychotherapy include, the fear of scrutiny from employers, and the assessment process of formal therapy. Therapy also focuses on a “working alliance” as the platform of change, which may not assist care-providers in regaining interest and focus in relationships or, generating trust, which is required to change their worldview (Abel et al., 2014; Blucket, 2005; Sun et al., 2013).
The coaching relationship in transformational coaching has been shown to be an essential element of helping care-providers manage their work and their life (Sun et al., 2013). Sun, Crowe, Andersen, Oades and Cairriochi (2013) found that transformational coaching emphasizes the relationship between coach and coachee, which was found to be far more beneficial for care-providers managing to work in mental health, than any other structure that was offered.
Transformational coaching is offered to everybody. It is goal orientated, future focused and evaluative (Cashman, 2003). It assumes that the coachee has the answers and the coach’s role is to develop a relational platform. The coach-coachee relationship fosters trust, acceptance and confidence (Sun et al., 2013). This can be significantly lost with compassion fatigue (Abel et al., 2014). Sun, Crowe, Andersen, Oades & Cairriochi (2013) refers to the “real relationship” (cited pp7) in coaching, whose ingredients are “genuineness” (the ability to be authentic with a coachee) and “realism” (honesty) (cited pp7). These are possibly the ingredients required to rekindle trust and challenge perceptions of threat and suspicion.
Transformational coaches are masterful in creating a platform to face dissatisfaction, generate personal responsibility for one’s safety and welfare, create personal empowerment, accountability and personal and professional identity. Sun, Crowe, Andersen, Oades & Cairriochi (2013) offered transformational coaching and skills based coaching to 39 mental health professionals in a rehabilitation service (to address compassion fatigue). Those individuals receiving transformational coaching reported a significantly stronger “real relationship” (cited pp14) and a significantly stronger “working alliance” (cited pp14). This demonstrates that transformational coaching can have substantial benefits including; the same healing properties as psychotherapy; a higher client focus in the relationship; and can eliminate the barriers of seeking traditional psychological interventions (Blucket, 2005; Sun et al., 2013). –
What might be helpful for a coach to know about compassion fatigue?
Even though an understanding of context can be acquired through powerful questioning and appreciative inquiry, it may be helpful to understand some of the issues that are unique to care-providers:
- For care-providers, compassion fatigue can be inevitable.
- A care provider may be accustomed to coping with their compassion fatigue alongside work colleagues, experiencing similar changes to their worldview.
- If individuals continue to work in the care profession, they will always be exposed to some trauma either vicariously or directly.
- Care-providers need a safe place to explore and begin to change their worldview. A transformational coach that manages to have a positive worldview and / or has experienced their own healing may best serve them.
The Professional Quality of Life Scale (Stamm, 2005) is used to reliably measure the impact of working in care-professions such as health, mental health, first responders, teachers, hospital staff or other caring roles. The ProQOL is a questionnaire that generates three scales that measure the following:
- Compassion satisfaction – the pleasure that a care-provider generates from their work.
- Burnout – feelings of hopelessness towards their work, difficulties doing the work or difficulties in the workplace.
- Compassion fatigue/ secondary trauma – experiences such as fear, sleeping problems, intrusive, distressing thoughts or images and avoidance of situations that are a reminder of the stories from the workplace.
Within the context of the “real relationship,” this tool may be offered to the care-provider as part of the platform to explore the personal cost of their work and enhance the appreciative inquiry process.
What might be helpful for a care-provider to know about transformational coaching?
At some point in a care-provider’s career, it will be essential to evaluate the personal cost of their work, especially when seeking change and improvement in their wellbeing. Transformational coaching can provide a safe, non-judgmental, exploratory platform, to begin the redirection of focus, to other aspects of their life, that are equally as meaningful and important to them as their work (Cashman, 2003). Transformational coaching can help a care-provider generate an identity outside of their profession, improve relationships, overcome avoidance, and seek pleasure and self-efficacy in non-professional areas. It can help individuals draw strength through accountability, self-responsibility and empowerment (Cashman, 2005). Inevitably, this can be a formula that challenges their worldview and boosts resilience in all aspects of their life (Abel et al., 2014).
In conclusion, transformational coaching is an important resource for care-providers that can directly address the effects of compassion fatigue. As a support structure, it is unique in its ability to provide a safe, non-critical platform, that allows individuals to explore the personal cost of their career, engage in self-evaluation and address their life as a whole, with priority and importance. Through transformational coaching, care-providers have an opportunity to foster a “real relationship” with their coach that builds trust and safety and challenges the chronic, negative effects of a trauma-driven worldview.
I dedicate this paper to my transformational coach, Carol Keith, with tremendous gratitude, who has helped me overcome my fears, and transform my worldview and my life.
I also want to thank the ICA, as it provided me with such an invaluable opportunity for transformation that it surpassed my expectations.
By Doukessa Lerias
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