Walden University
Abstract
Resilience as a Protective Factor Against Compassion Fatigue in Trauma Therapists
Abstract
Many adults in the United States experience posttraumatic stress disorder (PTSD)
within their lifetimes. Researchers have identified compassion fatigue (CF), which
debilitates mental health providers as a result of being exposed to their clients’ traumatic
experiences, as an occupational hazard. The purpose of this study was to examine
whether a correlation exists between the presence of CF and the level of resilience. A
confidential survey using the Connors-Davidson Resilience Scale, the Professional
Quality of Life Scale Version 5, and a demographic questionnaire were given to
graduate-level mental health clinicians who self-identified as routinely working with
and/or treating trauma victims in the past 6 months. Participants were recruited from the
New England Society for the Treatment of Trauma and Dissociation, the Metropolitan
Atlanta Therapists Network, Dallas Chapter NASW listserv, and the Georgia Therapist
Network. A multivariate analysis on the collected data was conducted to determine
whether a relationship exists between the resilience scale and the subscales of CF within
these population samples. According to study findings, there is a correlation between
resilience and the 3 compassion fatigue subscales—CF, burnout, and compassion
satisfaction. This study may lead to positive social change by helping guide clinicians to
find ways to enhance resilience, and therefore, decrease risks of CF.
Resilience as a Protective Factor Against Compassion Fatigue in Trauma Therapists
by
Daniel P. David
MSW, New York State University at Stony Brook, 2002
BA, College of New Rochelle, 1999
Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Human Services
Walden University
October 2012
Dedication
I want to dedicate this to my loving family and to all those brave first responders,
social workers, and other mental health clinicians that answered the call in the aftermath
of the September 11, 2001 terrorist attack.
Acknowledgments
“I believe in the spirit and resilience of the American people.” Barack Hussein Obama
Like most Americans on September 11, 2001, I experienced a major
psychological shift in my assumptive world view. Very few people can forget the events
of that day as the first news report of an airplane hitting the World Trade Center was
aired. I was living in Bayside, Queens, New York and was about to leave my home for
my graduate class in social work at New York State University at Stony Brook when the
tragic events began to unfold. The psychological shift for all of us caused a collective
shock that radically altered our fundamental world assumptions about the security of
our lives.
Americans have always felt far from harm, mainly due to the country’s geological
distance from most of the hot spots of war and conflicts. However, on that fateful day,
the country’s overall sense of security was shattered. Subsequently, America’s reactions
to the traumatic event continue to perpetuate more collective-trauma as this country
remains fearful and has turned to policies of war rather than taking a more enlightened,
humanitarian approach. We must remember that human beings are resilient and that our
country can become more resilient by taking a higher ethical, wiser, and more
compassionate approach to dealing with the global problems associated with poverty,
hunger, social injustices, and human suffering, which ultimately contribute to an
atmosphere of hate and violence—the impetus behind most terroristic acts.
During the days after September 11, 2001, I worked with the guidance counselors
at Benjamin Cardozo High School in Queens, NY to provide comfort and
encouragement to its students. Years later I learned about the hazards that mental health
workers experience as they became vulnerable to compassion fatigue and secondary
trauma when working with the trauma victims. As I researched compassion fatigue, I
wanted to understand what made some mental health workers more resilient than others
in spite of working with trauma victims and what could we do as researchers, academics,
and professionals to help protect our friends and colleagues in the mental health
profession. It is my hope that this research adds to our professional knowledgebase.
I must acknowledge and sincerely thank all the clinicians that responded to this
study. Your enthusiasm and zeal for understanding compassion fatigue and your desire to
know how we as professionals can remain resilient is remarkable and laudable. As our
honorable American military personnel return from the traumas of combat and war, we
need to be ready to provide them with an uncompromised quality of care and services, so
that they can properly heal and return to their families and mainstream society to lead
full and satisfying lives.
I am eternally grateful to my dissertation committee chairperson, Dr. Christine
Racanelli, PhD, and to my committee members: Dr. Barbara Benoliel, PhD and Dr.
Sylvia Kaneko, PhD for your expertise, guidance, keen insights, wisdom, patience,
and for faithfully staying the course with me through the research years. I owe each
one of you a great debt of appreciation.
I also appreciate my mother, Barbara David, for her love, encouragements, and
unfailing prayers, and my father, Daniel J. David, for his love and example of how to
believe in myself and how to live a fulfilling successful life. I appreciate my sister,
Annette Tanna, for always making me feel loved and welcomed in your family. Your
children, Jairus, Lauren, and Cameron are the best. I also write this in memory of my
younger brother, Scott J. David, who transitioned to the other side so long ago, yet he
remains missed and unforgotten. And, I dearly appreciate Kedrick J. Harrison whose
love as a son and cheerful demeanor has brightened my life in so many wonderful ways.
I want to express my deepest gratitude to Dr. Louis deSalle, PhD, my philosophy
professor, who believed in me and inspired me to push ahead toward higher academic
pursuits. And I want to thank my dear Atlanta friends Bruce Bridges, Jayne
Vandergriten, and Konnie Torban, PhD, for their encouragements, and for not giving up
on me when I often disappeared into my research and writing. I also want to express my
thanks to Angela Daniels for her help with proof reading and editing—always with a
good laugh and a beautiful smile, as well as thank Gaius Augustus for his positive energy
and supportiveness.
Table of Contents
List of Tables .................................................................................................................... vii
List of Figures .................................................................................................................. viii
Chapter 1: Introduction to the Study ................................................................................... 1
Background ................................................................................................................... 1
Problem Statement ........................................................................................................ 4
Purpose of the Study ..................................................................................................... 6
Significance of the Study .............................................................................................. 7
Research Questions and Hypotheses ............................................................................ 9
Limitations of the Study.............................................................................................. 12
Definition of Terms..................................................................................................... 12
Summary ..................................................................................................................... 18
Chapter 2: Literature Review ............................................................................................ 20
Introduction ................................................................................................................. 20
Background ................................................................................................................. 21
Traumatic Events and Trauma Diagnoses .................................................................. 23
Natural Hazards and Environmental Disasters ..................................................... 24
Human-generated Traumatic Events..................................................................... 25
Mental Health Providers for the General Population .................................................. 28
Expansion of Trauma Diagnosis ................................................................................. 29
PTSD: Prevalence in the General Population ............................................................. 31
PTSD: Increased Awareness ....................................................................................... 33
A Need for a Paradigm Shift ....................................................................................... 34
Resilience Theory ....................................................................................................... 34
Resilience Definition ............................................................................................ 34
Background of Resilience ..................................................................................... 35
Resilience and Developmental Psychology ................................................................ 38
Theoretical Framework of Resilience ......................................................................... 40
Resilience Construct: Critics and Proponents ............................................................. 41
Resilience and Similar Constructs .............................................................................. 43
Resilience as Positive Outcomes .......................................................................... 44
Resilience: Human Trait or Human Process? ............................................................. 46
Resilience as a Human Trait ................................................................................. 46
Resilience: A Dynamic Process ............................................................................ 50
A Metatheory of Resilience: Simultaneous Trait and Dynamic Processes ................. 50
Resilience Characteristics ........................................................................................... 53
Resilience and Competence ........................................................................................ 54
Resilience and Self-efficacy ....................................................................................... 55
Resilience and Interdomain Buffering ........................................................................ 56
Resilience Predictability ............................................................................................. 58
The Resilient Clinician and Coping Skills .................................................................. 59
CF and Satisfaction ............................................................................................... 63
CF across Care-Giving Professions ...................................................................... 64
CF: Distinct from Burnout and VT ....................................................................... 65
ii
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