Over the Abyss
crisis intervention teams following disaster
The term compassion
fatigue was suggested by Figley (1995) as an alternative to the earlier
concept of secondary traumatic stress disorder (McCann 1990). Both terms
describe the influence on mental health professionals of the therapeutic
encounter or intervention with victims of disaster suffering PTSD.
Here, I will
attempt to document observations from my experience in crisis intervention
and in supervision of professional helpers1 who are involved in
intervention immediately after and following a disaster with victims of emotional
trauma. The purpose of the article is to offer new understanding to the phenomena
looking at it from dramatherapeutic perspective, that is the lack of differentiation
rituals protection and initiation ceremonies and metaphoric myths. I shall
also use psychosocial and anthropological explanations to aid the understanding
of these phenomena. These reflections are based on my observations as a supervisor
of professional helpers soon after their contact with victims and survivors
of disaster and their family members, as well as my personal involvement
in such incidents. Let us first look into the term compassion fatigue and
what it entails.
fatigue, symptoms resembling the physiological, emotional, and cognitive
symptoms of victims appear among those who administer help to them. In 3%
to 7% of cases, these may be so severe that the professional helpers themselves
develop PTSD, with all its long-term implications (Hodgkinson & Stewart 1991).
of emotional burnout among mental health professionals has been widely researched
(Freudenbeyer 1974; Maslach 1982; Maslach & Jackson 1981; Pines 1993).
This literature describes a continuous process of burnout, composed of three
principal components: emotional, physiological, and mental (Pines & Aronson
1988). However, while burnout develops gradually, there are advance warnings,
and it is expressed in emotional fatigue, irritability, difficulty in concentrating,
and other physiological and mental phenomena, compassion fatigue may appear
suddenly, with no previous signs (Figley 1995). In addition, Figley (1995)
notes that, unlike mental burnout, here there is a strong sense of helplessness,
confusion, a feeling of being cut off from support, and psycho- somatic symptoms
similar to those of survivors or victims. However, recovery is also usually
The term compassion
fatigue was first coined by Joinson (1992) and later adopted by Figley.
Websters New Collegiate Dictionary (1989) defines compassion as sympathetic
consciousness of others distress together with a desire to alleviate
Likely Victims of Compassion Fatigue?
indicates two major components that lead to compassion fatigue: empathy and
exposure. Without both empathy and exposure, there is a low probability of
developing compassion fatigue. In principle, according to Figley and other
researchers, work with trauma victims (survivors, family relations, and the
injured) subjects helpers and those engaged in intervention to extremely
forceful exposure to trauma-inducing factors. This vulnerability is attributed
to several causes:
is a central instrument in helping and assessing injury and planning
the intervention program. Harris (1995) claims that empathy is the key
factor in the penetration of a traumatic event among crisis
of those involved in intervention have experienced traumatic events in
their lives. Because those who administer help after trauma cope with
a variety of events, at some time they inevitably encounter some that
are similar to the trauma in their lives.
may have unresolved traumas of their own.
with children in trauma has a particularly strong effect on the helpers
(Beaton & Murphy 1995).
the vulnerability of disaster helpers
discussion is based on my own observations as supervisor and interventionist
and discussions held with professional helpers, who offer psychosocial intervention
in Israel (Tel Aviv, Jerusalem, Kiryat Shmona), and the former Yugoslavian
states and Northern Ireland.
to prepare or to set the stage
usually take place without prior warning. They can happen at any moment,
anywhere, and to anyone. Massive, intense penetration of the event into our
lives (including direct television broadcasts from the disaster site, voices
and primary witnesses) immediately exposes helpers to the disasters that
they are meant to go to. Their daily ability to control the setting and the
staging is shattered as they are been called to act without appropriate warm
and the Role of Mental Health Professionals - an anthropological approach
to the myths about calamities.
Gulf War in 1991, civilian mental health professionals did not have much
direct and immediate exposure to real-time disaster situations. First of
all, the approach was that psychosocial helpers met the victims at emergency
relief centres, or in the clinic or in rare situations they were asked
to help families at the cemetery or in their homes. In other words, there
was a physical distance from the site of the disaster. Second, as telecommunications
technology required a studio, it took time to broadcast a disaster, not to
mention print a paper, and thus helpers were spared some of the most upsetting
immediate sights. Ethical limitations adopted by the journalists associations,
as well as almost absolute government control over electronic media, also
prevented some of the pictures from being broadcast. Thus professional helpers
working with trauma victims were exposed at a distance of both time and place,
limited almost exclusively to descriptions of the horrors by the victims
with whom they worked or to written reports and photographs in newspapers
or on television.
Gulf War, it was decided in Israel that civilian mental health professions
(social workers and psychologists) would also come to the scenes of disaster
and work according to Salmons (1919) Proximity, Immediacy, and Expectancy
(PIE) model, which had been adopted many years earlier by the Israels
defense forces mental health units (Solomon, 1993). The idea was that immediate
intervention, close to the site of the event, including conveyance of expectations
for recovery, would reduce the incidence of posttraumatic stress disorder
(PTSD) among victims, survivors, witnesses, and family relatives. The psychosocial
team was also expected to support the rescue workers, whom research indicates
as prone to develop PTSD (Hodgkinson & Stewart 1991).
which was meant to take place alongside or at the end of the rescue operation,
exposes psychosocial helpers to the horrific sights of a disaster on a much
greater scale. Furthermore, the CNN model of electronic media, of reaching
the site of the event, quickly setting up equipment, and broadcasting live
without editing (made possible by modern technology) also became prevalent.
Thus, a situation
in which the caregiver who comes into contact with victims in both physical
and temporal proximity to the disaster is exposed even before reaching the
area to the sights and sounds of the horror. He or she has often seen and knows more
than the victims themselves. This almost real exposure of the
helpers prior to even being on site, makes even minimal distancing difficult
and leads to an immediate identification with the survivors descriptions
not as a listener but as an equal and sometimes more informed partner, with
pictures of the event bringing arousal of strong emotions. This increases
the degree of empathy, identification, and assimilation of the event by the
helper. The fact that these scenes are being broadcast over and over again
are often described by helpers as having a semi-hypnotic effect on them drawing
them to look at it over and over again. Much like a nightmare the pictures
keep coming at them and make them feel as if they were actors /participants
and sometimes invisible survivors of the same incident.
admission rituals as boundary - defence factors of compassion fatigue
In the daily
routine of a mental health professional, there are several rituals that enable
differentiation and protection against the penetration of loaded or morbid
information into his or her life. These rituals are very helpful in the process
of getting into role. An important ritual is the intake,
the first stage of contact with the client. In this ritual, the caregiver
informs the client that he or she will do the interviewing, in order to collect
data that will help them and the client to understand his or her own situation
/ condition. The therapist records; the client answers. Thus a boundary is
drawn between the two. The ritual of acquaintance may or may not be limited
in time; they may spread over one or more intake meetings. However, even
if there is only one such meeting, the helpers study of the material
(after the client has gone home) helps him or her conceptualise the clients
problems and thus differentiates between the helper and the client.
No less important
is the ritual of setting of the time an element that is usually in
the sole control of the helper even if the needs of the client are taken
into account when determining the time. In this ritual, the helper controls
a central component, namely, the length and time of the meeting. A related
ritual is that of 50 sacred minutes.
importance is the ritual of the place. This is totally in the control of
the helper. It is usually his office and this territory was designed or at
least partially decorated by him thus making it to his or her territory.
There are also other rituals such as greeting and saying good-bye.
intervention in a disaster precludes the use of these rituals. There is no
time for an in-depth anamnesis; on the contrary, the professional literature
indicates that historic connection with the immediate distress (acute stress
reaction, ASR) and posttraumatic (PTSD) situations are counterindications
of recovery (Witstom 1989). Thus a central mechanism of the differentiation
process is eliminated.
the helper decide where the intervention will take place. Today secondary
interventions may begin near the incident site, at the mortuary as happened
in Israel since 1995 and lately in Northern Ireland in the Omagh massacre,
August 1998. It may include visits to grieving families in their home, neighbourhood,
or in the victims school.
length of the performance that is a crucial aspect of every play
is undefined. The work shift can be 18 and more hours. Sometimes the intervention
takes days with meetings every day or even several times during the day and
the work is always very intensive.
suggests in the time close to the event, daily encounter with the victim/s,
sometimes for several hours. Thus availability of helpers and intensity of
contact without the appropriate rituals exposes them more forcefully to the
intensity of the disaster.
proximity and psychological proximity (The lack of distancing)
crisis helpers are often called upon to provide intervention at locations
that are geographically close to their place of work or residence. This proximity
creates immediate identification and a sense of being a near miss, they
could have been the victims, yet they are called to help. This makes it very
difficult for the helpers to maintain distance from the event and its immediate
threatening significance to themselves and the wellbeing of their dear ones.
Because the site is the helpers natural setting, going home may expose
the helper time and again (that is even when the event ended) to the scene
and experience. It thus may weaken the defence mechanism by continuously
reminding him that this could have happened to me. This is called
between the victims or their relatives to the helpers life and sometime
to his or her peer group or family is called psychosocial proximity and this
can also create great difficulty. For instance, the disaster at Dizengoff
Shopping Centre, (Tel Aviv, Israel, April 1996) and the disaster at Apropos
cafe (Tel Aviv, Israel, March 1997) occurred in areas that were familiar
to most of the helpers. The victims were similar in age and socio-economic
status to those who came to help them (in the Dizengoff Shopping centre disaster
the aspect of injury and death of children, increased vulnerability and in
the Apropos cafe the victims were three social workers friends of
possible similarity between the helper and the victim, considering the random
and chance occurrence of the disasters and the geographic proximity noted
above, reduces the important aspect of distance and creates greater chance
of identification with the victims, and absorption of their story as part
of the victims story, identification and countertransference
and countertransference are well-known aspects of the therapeutic process,
which have been discussed widely, both in training and supervision of therapists
in general and crisis interventions as well. However, as explained here,
when in contact with disaster victims these two phenomena raise particular
intensity and take a heavy toll on those providing intervention.
work routine, mental health professionals make a point of coping directly
with transference either by direct confrontation with the client or through
other ways of processing it. However, when helpers meet with a survivor (or
family members) who say you remind me so much of my son, or you
are like a relative to me, it is difficult for them to deal with it
or work through it as transference. In fact, it is typically reported that
this is like a blow at the soft spot of my stomach; it makes me feel
significant to them, on the one hand, and places a tremendous emotional burden
on me, on the other. The helper goes along with it trying to fulfil
a fantastic (countertransferential) role of family member or friend.
burden of identifying with the victim is often expressed in the development
of intense, deep relations with the survivors, victims, and their families.
It is expressed in frequent home visits and telephone calls beyond the scope
of the intervention or therapy; the helpers explain that it is so important
to them; they need me so much.
is related to a concept, which I call the imprint of death of
the disaster. The survivor, victim, or family member becomes very attached,
like an imprint, to the image of the first lifesaver they happen
to meet. The helper goes through a similar process of clinging to the victim.
It is often expressed in undertaking tasks that he or she does not usually
do for clients, such as spending irregular work hours with the victim or
deviating from work definition such as calling all sorts of agencies on behalf
of the client. Also there can be great difficulty parting from the victims,
family members, and survivors and they may do all sorts of little services for
of the identification process are the development of physical symptoms similar
to those suffered by the victims, such as physical pain or intense anger
toward institutions, organisations, and service providers with whom these
professionals usually cooperate. Some helpers report dreams about the event
or about the victims and their families, as well as difficulty in concentrating
and apathy toward daily life (phenomena similar to grieving and mild depression).
does compassion fatigue develop?
I have seen
it developing within hours. Helpers are exhausted yet refuse to go home saying
or at least thinking, I cant leave these people now I am so significant
to them. They will not be able too make contact with someone else. Alternatively,
helpers will find themselves calling the families on the phone to see how
they are despite the fact that they have just seen them for a few hours and
the regular worker has already taken over the case.
occasions helpers disclose to me that they became so attached to the family
there wasnt a single day without them visiting the family just
passing by to say hello.
In one incident
the helper, a very experienced social worker learned at the mortuary that
the family had just moved house and as it happened did not have any furniture
in their living room. When she discovered it was close to her sons
flat she took the furniture from there and brought it to the family just
for the seven days of mourning.
the most common symptoms are those of physical aches, pains and changes in
appetite, sleep disturbances, moods, loss of interest in daily activities
and most of all, the routine workload of the office.
resemble very much the phenomena of combat fatigue. That is,
it develops quickly and the physical and emotional symptoms generally pass
after three to four days, although full return to routine often takes longer.
Dumpty, the savior myth or understanding the compelling urges to put all
the pieces together again.
Dumpty sat on a wall
Dumpty had a great fall
Kings horses and all the kings men
put Humpty together again.
to put Humpty together again is a great example of the hero or saviours
urge to help but not just intervene but to reassemble the pieces and put
them exactly as they were, anew.
definitely plays a major role in the compassion fatigue but what is the interplay between
Humpty and the kings men-the helpers?
creates a sudden break in our continuities (Omer & Inbar 1991;
Winnicott 1971). These continuities are the bridges that we build for ourselves
in order to ensure that yesterday will predict tomorrow, that we are stable,
that life is logical, that the world is a decent, logic, safe place, and
that people who are good have good things happen to them.
breaks our faith in a good world and confronts us suddenly with chaos. Typical
reactions are: I dont understand what is happening (cognitive
continuity); I dont know myself (historical continuity); I
dont know what to do, how to act here, what it is to be a bereaved
person/an injured and wounded person (role continuity); Where
is everyone, I am so alone, where are my loved ones? (Social continuity).
In my experience,
I have found that two contradicting thoughts run through the minds of victims:
is a nightmare any minute now Ill wake up and see that everything
is as it was; and
will only get worse; this is the end, it is horrible, it is a disaster,
it hurts more than any pain.
disaster is real and actually occurred, the first thought fades quite quickly
and the victim often enters catastrophic thinking that everything will become
need for someone from outside to organise the person, to anchor him or her
in reality, to take him or her somewhere safe, often leads some victims to
cling on to the caregivers with very strong emotional and physical force
(the death imprint), and like Humpty to project the verbal and non-verbal
existential message help me, tell me it is not true, put things together
the helper has a similar experience. On the one hand, there is tremendous
commitment, with a sense of mission and a desire to help, based on the belief
in his or her ability and power to put things together again - to stitch
it up (omnipotence); on the other hand there is a feeling of worthlessness.
This can be graphically represented as follows:
is a nightmare,
soon I will wake up
is nothing to do
it will only get worse.
I am very significant.
is so terrible. There is
no point. I am insignificant.
projects expectations of omnipotence on the helper, who is a sort of parent
figure, and this meets the helpers fantasy of being an omnipotent parent.
Valent (1995) uses the term attachment, I call it the parents magic
touch, comparing the contact with survivors to a parents calming
of a small child who has been hurt. An adaptive attachment, crying
and a call for help, lead to calming down the need for help by satisfying
needs (hugging, kissing, physical contact). The unification with the attachment
figure creates a sense of security, satisfaction, and relief. Rutter (1991)
claims that ethological theory correctly predicts that stress should enhance
to Valent, attachment can also be directed to a father or any member of a
group, and it operates among adults who too feel their vulnerability. It
is the universal experience of the parental magic touch, the
pain relieving kiss and hug of a small child, that in my eyes trigger the
helpers fantasy of omnipotence. Devora Omer, an author of Hebrew childrens
books, describes this phenomenon in a poetic way. She called her story, The
Kiss that Got Lost, telling about the phenomena that once the mothers
kiss was found it made magic on the crying child and pacified him. This experience
is closely connected to attachment and in my mind is at the basis of many
a helpers fantasy of the ability to bring things back to where they
were. Unfortunately this phenomenon disappears when the magic of childhood
ends and even then, when facing trauma or disaster it often does not work.
who projects such great helplessness, pain, and suffering looks to
us as helpless as a small child. The fierce desire to protect activates the
fantasy of omnipotence related to the experience of the parents magic
touch and makes the helper feel omnipotent. However, the failure of
the magic in the encounter with the disaster victim is liable
to make the helper feel helpless, empty, and self-doubting. In the literature,
this experience is referred to as impotence versus omnipotence. For years
I have been involved in emergency intervention and this term always seemed
inadequate to me until one day I realised why.
over the Abyss - a metaphoric understanding of the helper- victim interplay.
In his recent
book on traumatic stress, van der Kolk (1996) includes a chapter on the black
hole of trauma, in which he presents the description of the experience
of exposure to traumatic incident as being pulled into a black hole. In my
encounters and observations of disaster victims and their family members.
I have also often heard metaphoric descriptions, such as I am falling
into a black hole, I feel as though I am diving into a black
abyss, I am surrounded by black, or it is like an
ago, when reading the Book of Genesis I had a very profound experience and
suddenly had an insight as to what is this darkness over the abyss.
that so many victims of traumatic incidents experience describes their plea
for a glimpse of light, hope and recovery. If we look for a minute at the
description of the experience of the encounter with chaos as
described in Genesis 1:2:
the earth was without form, and void; and the darkness was upon the face
of the deep
in verse 3, And God said, Let there be light.
of chaos described by so many victims is well depicted by the encounter with
abyss and darkness. The sudden break in the continuities that the disaster
victim experiences increases the feeling of destruction of the order called
chaos in Genesis. This is the experience of the victim, the survivor, and
family members described earlier. The helpers are not at that distance as
they are stand at the edge of abyss, peeking into the eyes of darkness.
the darkness at the abyss involves not only a sense of impotence. I believe
that it is also an existential confrontation with immortality, fear of death
and injury, and concern for ones loved ones, values and beliefs.
of Genesis tells us about the establishment of order and the elimination
of chaos, lending further insights into the dynamics between the helper and
the victim. According to Genesis 1:3, in the confrontation of the darkness
and the abyss, there is a need for an omnipotent entity to bring the light.
In other words, it is the encounter of the victim with chaos that triggers
his/her plea for the omnipotent and to beg for light and in my view, visa
versa. The helplessness and chaos nurture the omnipotent urge of the helper.
There is a fascinating dynamic of the omnipotence of the helper,
which grows stronger through the needs of the victim, a dynamic that makes
the helper want to bring light, however weak and dim it might be. Because
the task of creating light is a task for the Almighty, the Omnipotent (and
therefore not possible for a helper), the question arises what then, is the
role of intervention?
the process of the biblical creation of order led me to the realisation that
since the creation of light is beyond our power, perhaps to restore
order by starting from the end, in other words to be human first.
It seems to me that this maybe is a clue to the help that we can give the
victim, namely: in the beginning (of the encounter with the victim) first
and foremost you need to be a compassionate person, not all-powerful.
It is interesting
that when the term PTSD was first introduced in DSM 3 (1980), the authors
used the concepts of disorder, which is parallel to the Latin term chaos.
Therefore, perhaps inadvertently, they coined a concept that describes the
chaos that arises as a result of the encounter with a traumatic event. Sometimes
it remains with the victim, his/her family or survivors forever. So, I believe
that we are talking not only about impotence but maybe on a much broader
experience, our human vulnerability.
the kings men or, How can helpers be helped?
from throughout the world (Harris 1995; McCammon 1995; Pearlman 1995; Mitchell
1985; Dunning 1988; Dyregrov & Mitchell 1992; & Shepherd 1994) and
from Israel (Shacham 1997; Lahad & Ayalon 1997; Klingman 1991) describes
a number of approaches to helping helpers in order to protect themselves.
Most of these mean either structured procedures like the CISD (Mitchell,
1985), supervision or spontaneous recovery. These approaches can be classified
according to the multidimensional BASIC Ph Model (Lahad 1993):
B Belief belief
system, hope, self-esteem, locus of control
A Affect direct
or indirect emotional expression
S Social friends,
logic, realism and cognitive techniques
Ph Physical physical
activity, relaxation and activity
some of the recommendations relate to more than one category. The beliefs
and value system is related to giving the event a new meaning, cultivating
the belief system that has been injured, finding meaning in suffering (Ayalon & Lahad
1990; Frankel 1970; Lahad & Ayalon 1994; Perlman & Saakvinte 1995
; White 1990).
here to encouraging speaking, ventilation, and legitimisation of direct and
indirect emotional expression after the event (Dyregrov & Mitchell 1993),
Lahad & Ayalon 1994.)
aspect includes social support, taking a role, belonging to the organisation
(Ayalon & Lahad 1990, Mitchell 1993, Elraz & Ozami 1994). Hodgkinson & Stewart
(1991) emphasise one particular role and that is the role of the team leader
as manager of the event, the one responsible for emotional health and physical
needs of the team.
responsible for work schedules referrals for rest, the organisation of talks,
provision of official recognition of the effort and helping create distance.
refers to the use of creativity, acting, guided imagery, relief, and distraction
(Lahad & Ayalon 1990; Breznitz 1983, Shacham & Ayalon 1997 Moran & Collers
aspect refers to preparation of the staff in advance for what may happen,
updating them in the course of the process, guidance and problem solving,
use of prepared programs and the CISD (Mitchell & Bary 1990; Lahad & Ayalon
1994; Binyamini 1984; Cherney 1995).
In the physical
aspect, the focus is on physical activity as a stress reliever, resting,
sleeping, and using relaxation and proper diet (Kfir 1990; Figley 1995).
supervision in vivo - Accepting the fact that the pieces can not be put
I met these
nine helpers a few days after they had been involved in a disaster. This
was their third incident in the past five months. All of them had been through
CISD sessions, but the group showed signs of fatalism, tiredness and apathy.
Some were in constant contact with individual and families of previous disasters
despite the fact that it was not their official role. Some were manifesting
anger and discomfort, but all were very dedicated to their role as helpers
and continued to report at any incident.
at the start of our meeting was a combination of He (me, the supervisor)
will solve all our problems and What can really be done it
is a hopeless case. I immediately registered in my head the parallel
processes between them and their clients moving on the continuity between
despair and omnipotence.
to start with movement (they have talked enough) putting on the different
sides of the room the words: Hope, Despair, Fear, and Courage. The instructions
were to move around the room and whenever they neared the signs either to
stop or reflect to write or draw anything, or make a movement or a sound.
Then I asked
each of them to choose one of the corners and meet the other members that
chose the same place. (If anyone found it difficult to choose a place s/he
was encouraged to find a position between the two signs depicting the feeling
at that moment). Everyone found a corner except for one person who positioned
himself between courage and despair.
step was to communicate for about five minutes without words (signs, sounds,
and movements) the feelings, thoughts, sensations that this corner brings
up. Then they were to share two to four sentences each, making a joint lyric
or prose and stage it as a choir. They had to decide on the rhythm tempo
or use a known melody. This took about half an hour.
were asked to perform the outcome and whilst watching and listening to write
down anything that came to mind or any image or sentence they liked from
in the group shifted to the Ph, S and I; that is active social and imaginative,
but still many tears were shed, even at that stage.
were asked to share what happened, some said that the poems and moreover
the melody or rhythm put them in touch with their impotence. Dark, darkness
and dark colours were very apparent in the images and words. A few members
were in tears talking about the permission to grieve. They said that the
poems and moreover, the time they were by themselves but still with others
gave them for the first time permission to express sorrow and grief publicly.
The helper who was in between the signs talked about impotence and inability
to choose; he cried and laughed at the same time and when asked to share
that, he said: crying is about my own loses in life, laughing is the
relief to be able to share that without fear.
session was opened by reading the poem from Alice in Wonderland. They
all knew Humpty Dumpty but did not connect it to their experience. The purpose
of bringing the poem was to look into their need to put all the pieces together,
how frustrating and impossible task it is, and all their anger toward the king who
in their mind expect them to put Humpty together again.
encouraged to take different roles and experiment with different inner and
outer dialogues. For most of them it was the first time they realised the
impossible role they were putting themselves in, the need to fix things for
others, their fantasy of replacing the irreplaceable and the enormous pressure
it put on them. The king was demystified and there followed great
attacks and expressions of anger and frustration were directed at the king who
expected so much of them. The last part of the session was a guided imagery
leading to a meeting with Humpty Dumpty and sharing with him what I can and
cant do for him. Sharing these thoughts in the form of a letter
was the end of the session.
session was dedicated to re-entry, to sharing skills or activities useful
in order to reduce symptoms, feelings or other bothering issues.
We put a
huge basket in the middle of the room and asked each one to write on a separate
piece of paper one thing that still bothers them. Each one could put as many
papers as s/he wants.
Then we asked
them to take a paper from the basket randomly and react to it, passing it
to the next person to add ideas. If anyone took out his/her own paper they
could either respond to it or put it straight back. However when the paper
finally came back to them, they were to keep it.
a very busy session, but at the end many of the problems received
some ideas and answers, some in the form of cognitive advice, others with
practical ideas yet some just with words of comfort and support.
participants were encouraged to either keep the answer or throw
it away, get rid of it by symbolically throwing it to the garbage or destroying
it and saying goodbye to it.
out of nine participants opted for the second option. We concluded the session
by talking about compassion fatigue and how to prevent it. Training
the participants in selfrelaxation, ended this last session.
I have tried
here to characterise what happens to helpers who are involved in intervention
at times of disaster. These thoughts are based upon my personal experience,
observations, and discussions with professionals whom I supervise and guide.
I have pointed
to components related to the absence of professional defence rituals, the
events penetration into consciousness through media exposure, geographic
and psychological similarity between those performing intervention and their
clients. I have also noted the phenomenon of the death imprint and its influence
on the helper.
chapter 1 of the Book of Genesis, and consideration of the concept of chaos,
I suggested another way of understanding the experience of the victim and
the helper and the fantasy of omnipotence related to the magic touch of
parenting evoked by the interrelationship of helper - parent; victim - child.
Understanding the experience of the encounter with the darkness in
the face of abyss may help to explain the powerful psychological effect
on the helper, once they get in contact with the abyss and the dark. This
in turn may be a partial explanation of compassion fatigue.
I have used the multidimensional BASIC Ph model to classify the methods that
have been found effective in helping care givers to reduce compassion fatigue
and demonstrated it with an example of group supervision. Naturally, these
are only initial suggestions, and as far as I know, the first attempt to
use creative methods in supervising crisis intervention teams and to use
a dramatherapy approach in this context. These ideas need to be followed
up and further researched. However they do provide insights that I believe
give us a direction for understanding and coping with the incidence of compassion
This was first published
in our publication Community Stress Prevention Vol. 4 2000 and later in
Traumatology 2000 Vol 6.
Community Stress Prevention