No abstract

Psychotherapists who work with the chronic illness tend to disregard their own self-care needs when focusing on the needs of clients. The article discusses the concept of compassion fatigue, a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference. It includes a multi-factor model of compassion fatigue that emphasizes the costs of caring, empathy, and emotional investment in helping the suffering. The model suggests that psychotherapists that limiting compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. The model also suggests that, to limit compassion stress, psychotherapists with chronic illness need to development methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. A case study illustrates how to help someone with compassion fatigue.

Objective: To describe the development and validation of the Secondary Traumatic Stress Scale (STSS), a 17-item instrument designed to measure intrusion, avoidance, and arousal symptoms associated with indirect exposure to traumatic events via one's professional relationships with traumatized clients. Method: A sample of 287 licensed social workers completed a mailed survey containing the STSS and other relevant survey items. Results: Evidence was found for reliability, convergent and discriminant validity, and factorial validity. Conclusions: The STSS fills a need for reliable and valid instruments specifically designed to measure the negative effects of social work practice with traumatized populations. The instrument may be used to undertake empirical investigation into the prevention and amelioration of secondary traumatic stress among social work practitioners.

Few studies have focused on caring professionals and their emotional exhaustion from working with traumatized clients, referred to as compassion fatigue (CF). The present study had 2 goals: (a) to assess the psychometric properties of a CF scale, and (b) to examine the scale's predictive validity in a multivariate model. The data came from a survey of social workers living in New York City following the September 11, 2001, terrorist attacks on the World Trade Center. Factor analyses indicated that the CF scale measured multiple dimensions. After overlapping items were eliminated, the scale measured 2 key underlying dimensions-secondary trauma and job burnout. In a multivariate model, these dimensions were related to psychological distress, even after other risk factors were controlled. The authors discuss the results in light of increasing the ability of professional caregivers to meet the emotional needs of their clients within a stressful environment without experiencing CF. Keywords compassion fatigue; secondary trauma; occupational stressAlthough the psychological consequences of providing social support and care to traumatized individuals have been noted for over 2 decades, relatively few studies have focused on formal caregivers (i.e., therapists, child protection workers, nurses, etc.) and their emotional response to dealing with traumatized clients (Figley, 1995). Studies have shown that providing such care can be both highly rewarding and highly stressful (Ohaeri, 2003). Individuals working in the caring professions, though, may have occupational environments and caregiving demands that increase the likelihood of adverse psychological outcomes (Figley, 2002a;Sabin-Farrell & Turpin, 2003).Theoretically, individuals working in the caring professions often attempt to alter the behaviors and emotions of their clients by providing emotional support (e.g., empathy), strategies for coping with emotions, or better cognitive management skills (Boscarino, 1997;Francis, 1997;Thoits, 1986). Within the context of formal caregiving, providing therapy to clients who have survived a traumatic event can be particularly stressful (Figley, 1995 (Figley, 1995;Nelson-Gardell & Harris, 2003;Schauben & Frazier, 1995). The adverse impact of working with clients who have a history of psychological trauma (e.g., sexual and physical abuse, military combat, or community disaster) has been described under a variety of terms: vicarious traumatization, secondary traumatic stress, and compassion fatigue (CF;Jenkins & Baird, 2002). Compassion Fatigue (CF)For the present study, we use the term CF. Consistent with most current usage, we defined this as the formal caregiver's reduced capacity or interest in being empathic or "bearing the suffering of clients" and is "the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person" (Figley, 1995, p. 7; see also Figley 2002a see also Figley , 2002b. Thus, CF is a hazard associated primarily with the clinical sett...

This manuscript provides practitioners a gateway into understanding assessment instruments for compassion fatigue. We first describe and then evaluate the leading assessments of compassion fatigue in terms of their reliability and their validity. Although different instruments have different foci, each described instrument measures at least one component of compassion fatigue. The final section discusses three factors in selecting a compassion fatigue measure: the assessment domain or aspect of compassion fatigue to be measured; simultaneous measurement, and; timeframe of what is being measured. Finally, we caution about interpreting scores since the measures were developed as screening devices.

Although all minorities experience inequalities, indigenous peoples in the United States tend to experience the most severe violent victimization. Until now, an organizing framework to explain or address the disproportionate rates of violent victimization was absent. Thus, the purpose of this conceptual article is to (a) introduce the concept of historical oppression, expanding the concept of historical trauma to make it inclusive of contemporary oppression; (b) describe the framework of historical oppression, resilience, and transcendence, which draws from distinct but related theoretical frameworks (that is, critical theory and resilience theory); and (c) apply the framework of historical oppression, resilience, and transcendence to the problem of violence against indigenous women. The proposed framework of historical oppression, resilience, and transcendence prioritizes social justice and strengths; it provides a culturally relevant framework, which can be used to explain, predict, and prevent violence. The article concludes with recommendations for future research, implications for practice, and recommended applications to other problems and populations.

This paper focuses on the consequences for providers of working with survivors of traumatic events, particularly criminal victimization. The paper reviews the relevant research and treatment literature associated with secondary traumatic stress (STS) and related variables (burnout, compassion fatigue, vicarious trauma, and countertransference). The latter part of the paper identifies the most important mitigating factors in the development of STS. These include good training specific to trauma work, a personal history of trauma, and the interpersonal resources of the worker. Implications for treatment, prevention, and research are discussed.

The objective of this study was to assess prevalence and predictors of mental health service use in New York City (NYC) after the World Trade Center disaster (WTCD). One year after the attacks, we conducted a community survey by telephone of 2368 adults living in NYC on September 11, 2001. In the past year, 19.99% (95% confidence interval [CI]=18.2-21.77) of New Yorkers had mental health visits and 8.1% (95% CI=7.04-9.16) used psychotropic medications. In addition, 12.88% (95% CI=11.51-14.25) reported one or more visits were related to the WTCD. Compared to the year before, 8.57% (95% CI=7.36-9.79) had increased post-disaster visits and 5.28% (95% CI=4.32-6.25) had new post-disaster treatment episodes. Psychotropic medication use related to the WTCD was 4.51% (95% CI=3.75-5.26). Increased postdisaster medication use, compared to the year before, was 4.11% (95% CI=3.35-4.86) and new medication episodes occurred among 3.01% (95% CI=2.34-3.69). In multivariate logistic analyses, mental health visits were associated with younger age, peri-event panic attack, posttraumatic stress disorder (PTSD) and depression. In addition, WTCD-related visits had a positive "dose-response" association with WTCD event exposures (P<0.0001). WTCD-related visits also were positively associated with peri-event panic, anxiety, lower self-esteem, PTSD, and depression. All three medication measures were positively related to PTSD and depression, and negatively associated with African American status. WTCDrelated medication use also was positively related to younger age, female gender, WTCD event exposures, negative life events, anxiety and lower self-esteem. Finally, while the percentage of New Yorkers seeking post-disaster treatment did not increase substantially, the volume of visits among patients apparently increased. We conclude that exposure to WTCD events was related to postdisaster PTSD and depression, as well as WTCD-related mental health service use. African Americans were consistently less likely to use post-disaster medications. Although the WTCD did have an impact on treatment-seeking among current patients, it did not substantially increase mental health treatment among the general population.