Compassion Fatigue and Self-Care Strategies among Addiction

170 Pages·2015·0.92 MB·English

by  Amanda Depippo

University of South Florida
Scholar Commons
Graduate Theses and Dissertations Graduate School
January 2015
Compassion Fatigue and Self-Care Strategies
among Addiction Professionals: A Qualitative
Study
Amanda Depippo
University of South Florida, [email protected]
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Depippo, Amanda, "Compassion Fatigue and Self-Care Strategies among Addiction Professionals: A Qualitative Study" (2015).
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Compassion Fatigue and Self-Care Strategies among Addiction Professionals:

A Qualitative Study

by

Amanda G. DePippo

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
in Curriculum and Instruction with an emphasis in
Counselor Education
Department of Psychological and Social Foundations
College of Education
University of South Florida

Major Professor: Herbert Exum, Ph.D.
Caroline Wilde, Ph.D.
Amy Menna, Ph.D.
Dinorah Martinez-Tyson, Ph.D., M.P.H.

Date of Approval:
April 30, 2015

Keywords: Addiction Counseling, Secondary Traumatic Stress, Addiction Professional Training,
Counselor Wellness, Training

Copyright © 2015, Amanda G. DePippo
Acknowledgments

I would like to extend my deepest gratitude to my husband, Rick, for your unwavering
support. This would not have been possible without you by my side and I love you dearly.
Thank you to my parents, sister, and meme for instilling in me the importance of
education and always loving and encouraging me along this journey, I love you. Thank you to
my mother and father-in-law for also encouraging me along the way and being willing to help in
any way.
I would like to express a special thank you to my committee members for your guidance,
knowledge, understanding, and support. To Dr. Exum, thank you for your calm and strong
guidance throughout the entire program. You have the wonderful ability to remain calm in the
midst of chaos and keep me grounded. To Dr. Menna, thank you for encouraging me, believing
in me, and for your wealth of knowledge. You are an amazing mentor. To Dr. Wilde, thank you
for helping me keep things in perspective. You have the uncanny ability to help me narrow
down my broad ideas and make them manageable. I am so grateful you began working for our
program when you did. To Dr. Martinez-Tyson, thank you for introducing me to qualitative
research and showing me how exciting it is. Thank you for your enthusiasm about my topic and
being available to help me in any way.
Thank you to my dear friend, Brenna. I am so grateful you started this program at the
same time I did. You were my sidekick and your friendship is an added bonus I received
through this process.
Thank you to our family friend, Beck Hurlbut. Little did you know that when you would
say, “I can see Dr. in front of your name,” it was inspiring and motivating for me. I could hear
those words in times of doubt and they helped keep me going.
Last, but certainly not least, thank you to my son, Roman, who entered this world as I
was nearing the end of my program. Thank you for giving me the final push to the end. I wrote
a lot of my dissertation with you sleeping peacefully on my lap, with you completely unaware of
how much you were motivating me to reach the finish line. I love you.
Table of Contents

List of Tables ...................................................................................................................................v

List of Figures ................................................................................................................................ vi

Abstract ......................................................................................................................................... vii

Chapter 1: Introduction ...................................................................................................................1
Background of the Problem .................................................................................................2
Statement of the Problem .....................................................................................................7
Significance of the Study .....................................................................................................8
Purpose of the Study ..........................................................................................................11
Objectives ..............................................................................................................11
Research questions .................................................................................................11
Study Assumptions ............................................................................................................11
Conceptual Framework ......................................................................................................12
Definition of Major Terms .................................................................................................15
Addiction/Substance abuse ....................................................................................15
Addiction professional ...........................................................................................16
Burnout ..................................................................................................................16
Compassion fatigue ................................................................................................16
Co-occurring disorder ............................................................................................16
Secondary Traumatic Stress (STS) ........................................................................17
Self-care/wellness ..................................................................................................17
Trauma ...................................................................................................................17
Scope and Delimitation of the Study .................................................................................17
Chapter Summary and Overview .......................................................................................18

Chapter 2: Literature Review ........................................................................................................20
Reintroduction to the Topic ...............................................................................................20
Addiction............................................................................................................................21
Addiction Professional .......................................................................................................22
Addiction and Trauma .......................................................................................................27
Compassion Fatigue ...........................................................................................................29
Training ..............................................................................................................................34
Addiction training ..................................................................................................34
Trauma training ......................................................................................................35
Evidenced-based practices and compassion fatigue ..............................................40
Compassion fatigue and self-care education and training .....................................41
Critical Analysis.................................................................................................................42
i
Self-Care Strategies/Wellness ............................................................................................44
Self-care/wellness literature ...................................................................................48
Chapter Summary and Overview .......................................................................................50

Chapter 3: Methods .......................................................................................................................52
Reintroduction to the Topic ...............................................................................................52
Research Questions ............................................................................................................53
Research Design.................................................................................................................53
Description of the Sample ..................................................................................................54
Inclusion criteria ....................................................................................................54
Exclusion criteria ...................................................................................................54
Sampling Procedures .........................................................................................................54
Procedures ..........................................................................................................................55
Data Collection Procedures ................................................................................................55
Pilot testing ............................................................................................................56
Pilot Test 1 .................................................................................................56
Pilot Test 2 .................................................................................................56
Description of Researcher and Clarification of Researcher Bias .......................................57
Trustworthiness ..................................................................................................................58
Credibility ..............................................................................................................58
Transferability ........................................................................................................59
Dependability .........................................................................................................59
Confirmability ........................................................................................................60
Data Analysis Procedures ..................................................................................................60
Chapter Summary and Overview .......................................................................................61

Chapter 4: Results ..........................................................................................................................62
Data Analysis .....................................................................................................................62
Results ................................................................................................................................63
Participant demographics .......................................................................................63
Clinical practice characteristics .............................................................................64
Theme I: Challenging clientele (7/7) ....................................................................65
Research Question 1: What are the Experiences Addiction Professionals Have
with Compassion Fatigue? ...........................................................................................68
Participant’s experiences with compassion fatigue (6/7) .......................................68
Compassion fatigue symptomology .......................................................................70
Theme II: Emotional impact (6/7) ............................................................70
Theme III: Distressing memories (4/7) .....................................................72
Theme IV: Avoidance of thoughts/feelings (2/7) .....................................73
Theme V: Irritable behavior (4/7) .............................................................74
Theme VI: Preoccupation with clients (6/7) .............................................75
Theme VII: Difficulty separating personal life from professional
life (6/7) ...............................................................................................76
Employment risk factors ............................................................................78
Research Question 2: What Role Does Training Play in Relation to Compassion
Fatigue? ........................................................................................................................80
ii
Theme I: Variability of addictions training (7/7) ..................................................80
Substance abuse class ................................................................................81
Trial and error ............................................................................................81
Personal recovery .......................................................................................82
Theme II: Lack of school training for treating trauma (6/7) .................................82
Seeking safety ............................................................................................83
EMDR ........................................................................................................84
Supervision ................................................................................................84
Theme III: Lack of school training about compassion fatigue/self-care
(6/7) ..................................................................................................................84
Theme IV: Supervision on compassion fatigue and self-care (6/7) ......................85
Theme V: Use of evidenced-based Practices (4/7) ...............................................86
Importance of Training in Relation to Compassion Fatigue ..............................................87
Theme VI: Prevention of compassion fatigue (6/6) ..............................................87
Theme VII: Awareness and confidence (6/6) .......................................................88
Research Question 3: What Self-Care Strategies are being used by Addiction
Professionals to Address Compassion Fatigue? ..........................................................90
Theme I: Physical exercise (6/7)...........................................................................90
Theme II: Mental escape activities (6/7) ..............................................................91
Theme III: Transitions (4/7)..................................................................................92
Theme IV: Basic needs (4/7) ................................................................................92
Theme V: Personal support to deal with compassion fatigue (5/7) ......................93
Theme VI: Professional support to deal with compassion fatigue (7/7) ...............95
Theme VII: Supervision/Consultation (7/7) .........................................................95
Theme VIII: Importance of maintaining boundaries (4/7) ...................................96
Advice to Other Addiction Professionals ..........................................................................97
Chapter Summary ..............................................................................................................99

Chapter 5: Discussion .................................................................................................................100
Demographics ..................................................................................................................100
Clinical Profile of Clients ................................................................................................101
Experiences with Compassion Fatigue ............................................................................101
Emerging Themes ............................................................................................................102
Compassion fatigue symptomology/risk factors ..................................................102
Training risk factors .............................................................................................107
Protective factors against compassion fatigue .....................................................113
Training ....................................................................................................113
Self-care ...................................................................................................115
Exercise ....................................................................................................115
Mental escape activities ...........................................................................116
Transitions................................................................................................116
Basic needs...............................................................................................117
Personal support .......................................................................................118
Professional support and supervision/consultation ..................................119
Maintaining boundaries ...........................................................................120
Benefits: Positive Client Change ....................................................................................121
iii
Conclusion .......................................................................................................................122
Implications for Counselor Educators .............................................................................125
Limitations .......................................................................................................................127
Recommendations for Future Research ...........................................................................127

References ....................................................................................................................................130

Appendices ...................................................................................................................................137
Appendix A: Recruitment Email .....................................................................................138
Appendix B: Informed Consent ......................................................................................139
Appendix C: University of South Florida IRB Approval Letter .....................................142
Appendix D: Interview Guide, Version 1 .......................................................................144
Appendix E: Interview Guide, Version 2, Dated 9/30/2014 ..........................................149
Appendix F: Compassion Fatigue Definition .................................................................154
Appendix G: Reference Table: Burnout vs. Compassion Fatigue .................................155
Appendix H: University of South Florida IRB Amendment Approval Letter ................156
Appendix I: Member Check Email to Participants ........................................................157
Appendix J: IRB Approval Letter for Follow-Up Interview .........................................158
Appendix K: Follow-Up Interview Questions ................................................................159

iv
List of Tables

Table 1: Participant Demographics .............................................................................................63

Table 2: Clinical Profile of Participant’s Clientele .....................................................................64

Table 3: Employment Risk Factors .............................................................................................79

Table 4: Basic Needs ...................................................................................................................93

Table 5: Most Helpful Self-Care Strategy ...................................................................................97

v
List of Figures

Figure 1: Conceptual Framework .................................................................................................15

vi