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Therapists' Experiences of Trauma, Compassion Fatigue, and Compassion Satisfaction: the Role of Post Traumatic Growth

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Therapists' Experiences of Trauma, Compassion Fatigue, and Compassion Satisfaction: the Role of Post Traumatic Growth Syracuse University SURFACE Dissertations - ALL SURFACE May 2019 Therapists' Experiences of Trauma, Compassion Fatigue, and Compassion Satisfaction: The Role of Post Traumatic Growth Tracey Reichert Schimpff Syracuse University Follow this and additional works at: https://surface.syr.edu/etd Part of the Social and Behavioral Sciences Commons Recommended Citation Reichert Schimpff, Tracey, "Therapists' Experiences of Trauma, Compassion Fatigue, and Compassion Satisfaction: The Role of Post Traumatic Growth" (2019). Dissertations - ALL. 995. https://surface.syr.edu/etd/995 This Dissertation is brought to you for free and open access by the SURFACE at SURFACE. It has been accepted for inclusion in Dissertations - ALL by an authorized administrator of SURFACE. For more information, please contact [email protected]. Abstract Experiencing traumatic events can have a profound impact on human beings, ranging from mild distress to severe symptomology. The mental health professionals that serve traumatized populations are also at risk of exposure in their work. While there are many factors that contribute to negative and positive consequences of clinical work with trauma, the influence of a therapist’s own trauma seems to have mixed findings. This study was designed to better understand the role of a therapist’s personal trauma on negative and positive associations of clinical work, specifically compassion fatigue and compassion satisfaction. There were no significant correlations found between the experience of personal trauma and compassion fatigue and compassion satisfaction. However, mediation analysis showed that post traumatic growth partially mediates the amount of compassion satisfaction experienced by therapists who are at risk for PTSD. In addition, compassion satisfaction partially mediates the relationship between PTSD and compassion fatigue. These findings have significant implications for training and supervision of therapists working in the field. THERAPISTS’ EXPERIENCES OF TRAUMA, COMPASSION FATIGUE, AND COMPASSION SATISFACTION: THE ROLE OF POST TRAUMATIC GROWTH by Tracey Reichert Schimpff B.S., LeMoyne College, 1993 M.A., Syracuse University, 1996 Dissertation Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Marriage and Family Therapy Syracuse University May 2019 Copyright © Tracey Reichert Schimpff 2019 All Rights Reserved Acknowledgements This has been such a journey for me. I certainly would not be where I am today without the love and support of my family. Thank you to my parents and grandparents who have always loved and supported me. You taught me to value education and view it as a priority and a source of endless possibility. To my mother who modeled a life of connection, service, and compassion. It is because of you that I believe I grew to understand and be empathic. To my husband, Craig, who has continuously supported me for over 30 years. You have been through this journey along with me in so many ways. You have been patient, took up the slack in our relationship and at home, and always believed in me. Your unconditional acceptance of me and those in the world have also encouraged me to do the same. To my beloved children, Aiden, Mia, and Nolen, you are my inspiration, my joy, and my motivation. I want only the best for you and have pushed myself to be the kind of mother and role model I hope you can look up to. You also have been patient, offered unconditional love, and shared millions of warm hugs that have eased the process for me. I would not have finished this without the support of my colleagues. Thom, you recreated this as a possibility for me, encouraging me to finish when I didn’t think it was possible. I am so grateful for your support. I want to thank the entire MFT department, especially Beth, Rashmi, and Dyane. You cheered me on and helped me to feel like I could complete this task, even when I doubted myself. To my committee, Linda, Rashmi, and Ellen, thank you all for your wonderful wisdom and guidance. Linda, you have always been a role model as a therapist, teacher, supervisor, woman, and mother. You have been an amazing mentor and advisor. I could not have done it without you. iv Table of Contents Chapter One: Introduction 1 Chapter Two: Literature Review 4 Introduction 4 Theoretical Framework 10 Systems Theory 12 Family Therapy and the Role of Self 13 Interpersonal Neurobiology 14 Trauma Theory 15 The Role of Empathy 17 The Negative Impact of Trauma Work 20 Prevalence 21 Vicarious Trauma 23 Burnout 24 Compassion Fatigue 25 Connection Between Vicarious Trauma, Burn Out and Compassion Fatigue 27 Factors in Developing Compassion Fatigue 30 Gender, Age & Experience 31 Amount of Exposure 32 Training 33 Workplace Stress 33 Personal Trauma 35 Factors that Decrease Compassion Fatigue 39 v Positive Impact of Trauma Work 41 Vicarious Resilience 41 Vicarious Post Traumatic Growth 43 Compassion Satisfaction 45 Relationship Between Compassion Fatigue & Compassion Satisfaction 48 Personal History of Trauma 50 Critique of Current Research 54 Need for the Study 56 Chapter Three: Methodology 58 Research Questions 58 Design 59 Sample 60 Recruitment 60 Procedure 61 Measures 62 Demographic Information 62 Compassion Fatigue and Compassion Satisfaction 63 Exposure to Trauma 64 Severity of Trauma 65 Post Traumatic Growth 66 Data Analysis 67 Chapter Four: Results 70 Participant Demographics 70 vi Descriptive Statistics : Means and Correlations 71 Hypothesis Testing: Group Differences 74 Research Questions: Mediation 78 Additional Results 81 Summary 82 Chapter Five: Discussion 84 Personal Trauma 84 Correlations 87 Demographic Variables 90 Compassion Fatigue, Compassion Satisfaction and Post Traumatic Growth 94 Research Questions 96 Focus on Strengths 98 Limitations 99 Clinical Implications 101 Future Research 104 Summary 106 Appendices 108 Appendix A: Demographic Questionnaire 108 Appendix B: ProQOL 109 Appendix C: LEC 110 Appendix D: PCL- C 111 Appendix E: PTG 112 Appendix F: Informed Consent 113 vii Tables 115 References 133 viii List of Tables Table Page 1. Participants by Gender 115 2. Participant Race and Ethnicity 116 3. Educational Degree of Participants 117 4. Participant Years in the Field 118 5. Profession of Participants 119 6. Percent of Trauma Cases 120 7. Participants That Received Trauma Training 121 8. Quality of Supervision 122 9. Traumatic Life Events Experienced or Witnessed 123 10. Participants Receiving Personal Therapy 124 11. Participants Receiving Personal Therapy 125 12. Analysis of Variance of Compassion Fatigue with PTSD and Post Traumatic Growth 126 13. Analysis of Variance of Compassion Satisfaction with PTSD and Post Traumatic Growth 127 14. Analysis of Variance of Compassion Fatigue Based on Trauma Caseload 128 15. Analysis of Variance of Compassion Fatigue Based on Years in the Field 129 16. Analysis of Variance of Compassion Satisfaction and Years in the Field 130 ix 17. Analysis of Variance of Compassion Fatigue by Educational Degree 131 18. Analysis of Variance of Compassion Satisfaction by Educational Degree 132 x 1 Chapter One: Introduction Trauma is pervasive. It has become a focus in our world and in our communities. Anyone who watches the news is aware of the violence related to war, crime, and various forms of abuse. Most are also aware of the ways in which being a victim of violence or witnessing traumatic events can have a negative impact on human beings. Many who experience or are exposed to traumatic events have reactions that are logical responses to the experience. Slowly, our mental health system is recognizing the ways in which trauma contributes to client symptomology and behavior. The increased awareness of the impact of trauma has led to an increase in the need for and use of mental health services. With that has come knowledge of how to assist those who suffer from trauma. From direct response workers to medical professionals and human services workers to mental health practitioners, there are many who are exposed to trauma through their work. Practice and research have also acknowledged the impact of this trauma work on the professionals (Cocker & Joss, 2016; Figley, 2002; Pearlman & MacIan, 1995; Sinclair, Raffin- Bouchal, Venturato, Mijovic-Kondejewski & Smith-MacDonald, 2017). Theorists have defined such concepts as vicarious trauma and compassion fatigue to explain the deleterious effects of exposure to trauma through one’s job (Figley, 2002; Huggard, Law & Newcimbe, 2017; McCann & Pearlman, 1990; Newell, Nelson-Gardell, MacNeil, 2016). To date, much of the research on both the impact of trauma and the impact of working with traumatized people has focused on negative associations. Yet, not every human being experiences symptoms following a traumatic experience. Similarly, not every professional will develop vicarious trauma or compassion fatigue as a result of their work. 2 There has been evidence of positive effects of working with those who have experienced trauma, such as compassion satisfaction and vicarious resilience (Craig & Sprang, 2010; Engstrom, Hernandez, & Gangsei, 2008; Martin-Cuellar, Atencio, Kelly & Lardier, 2018). Post traumatic growth has been viewed primarily in patients who demonstrated growth after medical trauma (Shakespeare-Finch & Enders, 2008), but it has also been noted in people with other types of trauma (Calhoun & Tedeschi, 2004; Triplett, Tedeschi, Cann, Calhoun, & Reeve, 2012). The concept of vicarious post traumatic growth builds upon the theory of post traumatic growth, although
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