TRAUMA AND COMPASSION FATIGUE: HELPING THE HELPERS

BY DR. JACINTO INBAR Director, "Etgarim" Center for Integrative-Cognative-Befiavior, ,

and DR. MICHAEL GANOR Senior Consultant and Director of Training, Organizational Development and Research, Jerusalem Association of Communiry Councils and Centers, Jerusalem, Israel

This article deals with the psychological effects of exposure to continuous trauma events on professionals, who themselves are in need of supportive interventions. These profes.sion­ als, who are in the secondary circle of trauma, experience compassion fatigue or emotional burnout. Structured interventions are now in place to strengthen the resilience of helping professionals.

he events that occurred in Jerusalem dur­ populations they are trying to help, they Ting the in the last two sometimes neglect themselves and their own years have considerably affected individuals emotional needs. These persons experience and families, as well as entire communities symptoms of post-traumatic stress disorder in Israel. They have also taken their toll on (PTSD), enhanced by the emotional burnout Jewish professionals, particularly psycholo­ of having to support others while lacking gists and social and community workers, support for themselves, a condition known as who must help either at the scene of a suicide compassion fatigue. Compassion fatigue is bombing or carry out such tasking responsi­ described by Figley (1995) as "a state of bilities as accompanying a mother to identify tension and preoccupation with individual or the remains of her child at the morgue. The cumulative trauma of clients as manifested in professionals work with mourning families, one or more ways: reexperiencing the trau­ trying to alleviate their pain—as if it were at matic events, avoidance/numbing of remind­ all possible. Included in this group are mem­ ers of the event, [or] persistent arousal." bers of ZAKA—Chasidic arriving first Compassion fatigue symptoms include on the scene who recover the corpses and depression, anxiety, alienation, feelings of body parts of fatal casualties of terror attacks incompetence and irrelevance, and sleep dis­ for identification and burial—and medical orders. When subjected to long periods of personnel: doctors, nurses, and paramedics stress, a gradual aggravadon of this burnout who confront these atrocities every day and process diminishes the effective functioning who are inevitably affected by what they see. of professionals, resulting in their excessive The professionals and volunteers men­ distancing themselves from clients, impaired tioned above are included in what has been competence and low energy, increased irri­ named "the secondary circle of trauma." tability with supporters and colleagues, and Their individual resilience is put to a maxi­ more. mum straining test when they witness terror The need to address the special needs of and death on such a massive scale and on professionals in these situadons has become such a continuous basis. Professionals and apparent only recently, due to the mere fact volunteers have been known to experience that the duration of the security condition in symptoms of severe stress, which comes on Israel has been underestimated. No system­ top of their already difficult daily workload. atic study has been conducted so far, so that Investing so much emotional energy in the the scope of the problem is not yet well

109 Journal of Jewish Communal Sen'ice I 110 defined. From fragmented information gath­ or limiting the amount of time dedicated to ered from recent experience in Jerusalem, we work), perfecting self-relaxation and tech­ can attest to the remarkable resilience of niques as such guided imagination, medita­ most professionals in this field. However, tion, and more. growing numbers are showing several symp­ toms of compassion fatigue. INTERVENTION AT THE Apparently, most professionals engaged PROFESSIONAL LEVEL in helping roles have managed to design and On the professional level, persons in the implement "self-made" support systems, secondary circle of trauma participate in based mainly on social networks and profes­ workshops and interpersonal supervision sional colleagues, in order to avoid emo­ aimed at developing "caring distancing" tional burnout. Nevertheless, the need for techniques. The use of humor is also encour­ some kind of stmctured prevention, support, aged—through workshops and e-mail net­ and strengthening processes is evident. In works—as a useful tool for enhanced pre­ response to repeated demands from helping vention and effective coping. professionals to help them avoid recurrent exposure to memory-arousing events, first steps have been taken to implement pro­ COGNITIVE-BEHAVIORAL grams specifically intended to help the help­ INTERVENTION ers deal with indirect traumatization. This method addresses the way that pro­ Such interventions fall into one of four fessionals perceive and interpret reality, categories: (I) intervendon at the individual which directly affects their coping behavior. level, (2) intervention at the professional Intervention programs are designed to de­ level, (3) cognitive-behavioral intervention, velop cognitive coping skills under stress; and (4) systemic social-organizadonal inter­ one such example is stress innoculation vention. training, or SIT, which includes the practice of conditioned reactions to specific traumatic INTERVENTION AT THE events. Workshops and training teach profes­ INDIVIDUAL LEVEL sionals how to identify potential symptoms of stress and burnout in themselves, promote On the individual level, professionals the development of self-control, and improve must be helped to regain basic skills, such as problem-solving abilities, particularly in sit­ effective dme management and restructuring uations requiring teamwork coordination. their daily routine. This may, in tum, require These workshops usually include a compo­ the ability to change long-standing habits nent dedicated to creative problem-solving and readjust rapidly to new situations. For and "thinking outside the box." The cogni­ example, a professional may be used to hav­ tive-behavioral workshops help develop psy­ ing dinner at a set time, at home with his or chological resilience, including a sense of her family. The individual-level intervention hopefulness and learned optimism, and teach method may help that professional restruc­ ways to design social and professional sup­ ture the day so that he or she may still dine at port systems. home, but at a later time. The intervention aims to enhance self-consciousness, includ­ SYSTEMIC SOCIAL-ORGANIZATIONAL ing raising body awareness and recognizing INTERVENTION fatigue symptoms. Another type of individual intervention is This intervention method occurs mainly to allot structured time for sports and leisure in institutions handling crisis and trauma sit­ activities. The method promotes a height­ uations. Specific methods of intervention in­ ened separation between work and family clude designing an organizational culture life, stressing borders (not taking work home that prevents or moderates the creation of

WINTER/SPRING 2003 Trauma and Compassion Fatigue /111 burnout condition, and encourages effective The need for them grows with every ter­ coping; developing a leadership style that rorist attack. It is of vital importance to treat promotes joint vision, creativity, and prob­ the helpers so that we do not reach the absurd lem solving; and developing social and pro­ situation where victims of an attack are fessional support systems, such as the "Buddy treated and helped, but those who help them System," where professionals share their experience such burnout that they can no concerns and experiences with each other. longer function as social service providers or even continue their own life patterns as CONCLUSION usual. We hope that these pilot programs will

The field of "helping the helpers" is sfill serve as a basis for many other intervention relafively new. Israeh professionals have had models in the future, in Israel and anywhere to develop it in real-time, under considerable else where professionals and volunteers ded­ time and other pressures, and with no exist­ icate their time, attention, and support to help ing model to use as a basis. The first pilots of those who are in need. these programs are currently being devised and implemented under the auspices of the Department of Welfare Services at the REFERENCE Jerusalem Municipality and the Jerusalem Association of Community Councils and Figley, C. R., & Klebert, R. J. (1995). Beyond the Centers.' "victim": Secondary traumatic stress. In R. J. Kleber, C. R. Figley, & B. Gerson (Eds.),

'For more information, please contact Dr. Beyond trauma: Cultural and societal dy­ Michael Ganor at [email protected]. namics. New York: Plenum Press.

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