Compassion fatigue in pastoral caregiving besides the emotional and physical factor of exhaustion describes fundamentally the barrier of spiritual exhaustion and its connection to depleted hope and an inappropriate theological framework of reference ; it is about a kind of normal acknowledgement of personal limitation, helplessness and hopelessness within the realm of commitment, motivation and meaning-giving. The emphasis is on the quality of one's belief system, vocation, professional conviction and appropriate theological theory, normative framework, attitude and philosophy of life, as being more a qualitative and hermeneutical issue level of meaning and interpretation: what is at stake here?
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What then are the spiritual implications of compassion fatigue on hope care? Liminality: Border-awareness within the in-between of life and death. Compassion fatigue surfaces within the awareness of liminality. On the threshold between life and death, hope and helplessness or hopelessness, compassion fatigue wrestles with own transience and woundedness.
Compassion fatigue is to a certain extent an indication of a border-awareness: The boundaries and barriers set by inexplicable human suffering, pain and tragedy. The concept liminality is connected to an awareness of threshold, margins and boundaries. One becomes aware of possibly frightening borders and barriers that are difficult to overcome and to cross.
The Theology of Suffering and Death: An Introduction for Caregivers
A 'border' is not merely about human limitation, a lack of capacity, a psychological or mental block, a cultural difference, inappropriate coping skills or the boundaries of a personal make-up. Borders are part of life and our experience of transience. Border-experiences are part of our being-in-this-world Heidegger existentialia ; structures of Dasein. The most definite border and demarcation of life is death. Thus, the reason why M.
Heidegger, in Sein und Zeit , asserts that life should be understood within the limitations set by death 7. A border is necessary because it sets off Abgrenzung ; it defines particularity and articulates demarcation. It deals with identity and, as an ontological category, provides a sense of hermeneutical framework in order to detect meaning in life and to understand the character of an issue or phenomenon. Borders help to differentiate between text and context. One can say that a border-awareness creates different spaces and articulates diversity.
Borders cut one down to size and refer to the essence or design Entwurf and of being So-sein ; modes of being. Borders as threshold-situations create opportunities for differentiation; a border can open up new avenues to gain clarity regarding what really counts in life. Borders are never definite but heuristic categories and frameworks for meaning within the dynamics of interpretation Verstehen. As a result of the fact that a border, as an existential category, deals with dying and estrangement, a border is related to the limitations set by relationships a relational phenomenon within the human predicament of transience, suffering and human failure and the experience of vulnerability and non-sense.
A border as a phenomenon of liminality Begrenzt-sein shapes us in several ways:. Identity and the human quest for dignity ethos : Who am I? Can I cope with life and suffering? As a human being particularity, locality, time, historicity and space set specific limitations to identity. The problematic issue: failure and sense of incompetence. Who is God? Can God cope with life and suffering? The problematic issue: theodicy 8. Our awareness of helplessness and the need for 'signals of transcendence'.
How can one deal with 'fate' and unavoidable boundaries in life? The problematic issue: hopelessness. The challenge to heal and to care; to make a difference and enhance the quality of life: The quest for help and healing. What is care and how do I care within the awareness of transience and tragedy? The problematic issue is compassion.
With reference to the previous outline on the phenomena of 'border' and liminality as existential realities Heidegger: existentialia , one can argue that spiritual exhaustion, and its connection to compassion fatigue, surfaces within the experience of border, liminality and paradox.
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Spiritual exhaustion and the interplay between paradox, antinomy and polarity. As an existential exponent of spiritual exhaustion, the spiritual tension in compassion fatigue is related to three interrelated issues, namely: paradox, antinomy and polarity. Compassion fatigue wrestles with contrast and contradiction within the awareness that a dialectical synthesis, or rational solution, regarding the meaning in suffering, would not alleviate the pain of the irreparable loss or the vulnerability of the sufferer's predicament.
The fatigue manifests because caregivers are exposed to the pain of tragedy and irreparable loss. On the other hand, caregivers are exposed to their own spiritual borders of coping. But at the same time, they become painfully aware of the fact that, resulting from the spiritual and theological notion of calling and vocation, directed by the notion of 'costly grace' Bonhoeffer 9 , they cannot merely quit and give up. Therefore, compassion fatigue in pastoral ministry is about spiritual suffering at the brink of paradox, antinomy and polarity.
Compassion fatigue grapples with the following contradictions on a spiritual level:. Paradox : The self-contradictory proposition that appears to be obviously absurd or nonsensical. The contradiction is about apparent, seemingly opposite factors that are maintained at the same time. As Paul asserts in 2 Corinthians , 'as unknown, and yet are well known; as dying, and see - we are alive; as punished, and yet not killed; as sorrowful, yet always rejoicing; as poor, yet making many rich; as having nothing, and yet possessing everything'.
Antinomy : This involves two contrasting perspectives regarding the same issue or object, each with a legitimate view. Each side is legitimate and equally tenable despite their seeming lack of reconciliation the legitimacy of two equally tenable opposites. In an antinomy, both sides are substantiated by factual evidence. For this reason, one is compelled to accept both positions as legitimate Hernandez On the one hand it seems in Scripture as if God is present in suffering. On the other hand, in the forsakenness of Christ, God the Son protests against all forms of human suffering and it seems as if God is absent.
How can both be true at the same time? Somehow, God is against suffering as well as engaged in suffering. Two apparently contradictory ideas represent and convey two spiritual truths: Divine absence forsakenness and divine presence comfort. Polarity : This describes the dynamics and tension in reciprocity created between contrasting opposites. When two contrasting principles are placed side-by-side or invoked simultaneously, tension predictably arises. Two opposites within a dual tension are then maintained and accommodated at the same time as part of the reality at stake.
For example, human beings are exposed to sin. However, if they transgress they will be pardoned due to the mercy and grace of God. Aware of grace, believers still continue to sin, knowing that they are guilty, but they will be forgiven when they confess.
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In their attempt to come to grips with paradox, the awareness of incompetence affects spiritual resources and the ability to cope with the demands in pastoral ministry. The result is: a lack of spiritual resilience and a spiritual courage to be. Lack of spiritual resilience. As said, compassion fatigue is closely related to the trauma of overexposure.
However, it cuts deeper. It is fundamentally about the illness or spiritual pathology of 'professional disempowerment'. It is a condition related to the sickness of professional helplessness, and the fear not to be able to deal furthermore with human suffering in a sustainable way; it describes more or less a condition of habitual incompetence. In addition, this is of paramount importance: compassion fatigue does not primarily reside in a lack of skills know how , but in a lack of resilience within the face of the desperate situation of human beings and the predicament of an overwhelming sense of failure and vulnerability.
The question is not merely: can I cope? The question is: how do I proceed, and do I have the courage to be? Compassion fatigue infiltrates the realm of the conative: motivation and commitment.
It is in this regard that the notion of resilience surfaces. Psychology has identified and described the internal or psychosomatic ability to cope with external pressure, as a mode and habit of resilience from the Latin resilire : rebound. It refers to the capacity of the will not to be hampered by the external barriers or pressure; it is about an attitude, not to be cast down, but to bounce back with inner strength and constructive, positive energy fortigenetics.
Attitude in pastoral ministry is described as phronesis.
The Theology of Suffering and Death: An Introduction for Caregivers - CRC Press Book
The mind and attitude of pastoral caregivers are, according to Phillipians , directed by the mind phronesis of Christ, his humbleness and sense of sacrifice. Thus, my basic contention and assumption that in caregiving, compassion fatigue, in the pastoral ministry of caregiving, is closely related to the confusion between the affective dimension in compassion and the noetic and paradigmatic framework for compassion which is derived from the Christ- phronesis. In this regard, a God-image, fed by the notion of costly grace, can play a decisive role in spiritual exhaustion.
This is also the reason why inappropriate God-images for example the all-power concept of omnipotence - God as pantokrator Louw contributes to the condition of spiritual exhaustion. The spiritual reasoning develops: if God is all-powerful and does nothing to prevent disasters, I become disempowered as well; I feel helpless and overcome by suffering; I am spiritually impotent.
What one should keep in mind is that compassion fatigue infiltrates our theological paradigms and basic human quest for meaning; it becomes a kind of spiritual yearning for wholeness and human dignity resulting from an overwhelming, temporary affect of failure. Compassion fatigue actually blurs caregivers' long-term vision and efficient caring strategy. One can say that compassion fatigue develops as a by-product of the failure to 'see' the 'bigger picture'. One becomes particularly overwhelmed by the anxiety for the loss of skilfulness and significance that one goes temporarily on a spiritual strike.
It seems as if technical, counselling skills or managerial skills seem to fail and that one is not equipped to meet the demands of human suffering in a sustainable way. This feeling of failure is then projected onto an 'impotent God' as well. However, in a diagnostic approach to compassion fatigue in pastoral ministry, one should reckon with the fact, that the fatigue is not merely 'spiritual' on a noetic level, but also emotional and, thus, a psychological condition as well. The connection: Compassion fatigue - burnout - vicarious suffering. Compassion fatigue, burnout and vicarious suffering have in common that they are all related to the affective component in caring and deal with the predicament of a kind of psycho-spiritual helplessness.
Without any doubt, all three mentioned phenomena have a decisive impact on the physical, emotional and mental level of exhaustion. They all deal with exhaustion caused by a kind of psychological depletion; such as the psycho-physical inability to cope with the demands emerging from one's every day, existential environment. Most of the time, the categories of compassion fatigue, burnout and vicarious suffering are viewed as exchangeable concepts Figley However, although all of them are concerned with a mode of affective depletion, one should differentiate between them.
This should be implemented in order to enhance a profound diagnostic description and, thus, contribute to spiritual healing within the helping professions: the so-called healing of the wounded healer. Burnout is often described as a state of physical, emotional, and mental exhaustion caused by a depletion of ability to cope with one's everyday environment; it is a result of frustration, powerlessness and inability to achieve work goals Valent It is closely linked with professionalism as the urge to perform always excellently in terms of the achievement ethics of pragmatism and functionalism.
One can say, between burnout and compassion fatigue, that there is a difference in terms of grade, not in terms of character and essence. Both involve levels of exhaustion. The difference resides in the fact that burnout refers more to over-performance resulting from doing functions and the pressure of achievement ethics resulting in performance anxiety and a sense of regular failure being incompetent.
On the other hand, compassion fatigue refers more to over-exposure resulting from acute sensitivity over-empathising. As a result of depleted being functions and the trauma of being overwhelmed by the desperate situation of suffering see the tsunami in Japan , a kind of nausea or negativity sets in. In compassion fatigue, the wounded healer now becomes the victim of being wounded by the wounds and pain of the other. Without any doubt, compassion does affect the counsellor and cause harm in terms of attitude and aptitude.
The danger, of becoming a victim of the sufferer's suffering, can be linked to the phenomenon of vicarious suffering , namely how the pain of the other becomes one's own pain and challenges one to start suffering on behalf of the other. Vicarious suffering is closely related to the fact that in Christian spirituality, one is called to the ethos of sacrificial ethics costly grace. In order to help, one should be prepared to sacrifice one's own agenda for the sake of the other. In Figure 1 10 , the differentiation between compassion fatigue, burnout and vicarious suffering can be summarised as follows.
Burnout points more to the level of the professional identity regarding occupation and job demands; it is closely related to the work stress of the workaholic. The self becomes depleted resulting from an over demand on skills. Burnout often results in a kind of reactive depression with the intention to quit and the wish to rather do something else. Healing is primarily focused on medical treatment: the prescription of drugs. It also implies a rescheduling of an overloaded work schedule, perhaps even a change in terms of one's job and career future planning.
Compassion fatigue points more to the level of spiritual stress because the pain and helplessness of the other infiltrates the caregiver's framework of meaning and conceptualisation of pain and suffering. The wounded self healer develops as a natural and normal reaction to overexposure resulting in the coping strategy to put everything temporarily on hold. Healing should be part of the normal procedure in caregiving, namely debriefing within the safe and quiet space of a retreat.
Sharing with other caregivers in the field, and an opportunity to revisit one's theory and framework of meaning, helps to gain a kind of spiritual resilience, and perhaps a change towards a more appropriate God-image and new spiritual purpose repurposing. Continuous exposure to suffering affects one's whole being; especially one's attitude habitus and internal make-up and cognitive framework.
Internal confusion and a kind of over identification psychological impact resulting from being overwhelmed by the desperateness of people leads to traumatic experiences; often irrational behaviour and a kind of obsession to help and to replace the suffering of the other. Vicarious suffering then points to the phenomenon of internal doubt spiritual strike and an intensified awareness of an anxiety for loss resulting from the inevitable fact of tragedy in life.
Because of an over-identification with the predicament of the sufferer, one is easily exposed to the danger of becoming the victim of the trauma. Healing should focus on reframing; such as the attempt to revisit one's paradigmatic framework, patterns of thinking, commitments, convictions and belief systems and to re-evaluate and transform them within the light of existing challenges change of meaning. Reframing is then about the attempt to change the conceptual and emotional setting or viewpoint in relation to which a situation is experienced, and to place it in another frame which fits the facts of the same concrete situation equally well or even belter, and thereby changes the entire meaning Capps Reframing intends to out-manoeuvre the dysfunctional attitude of being a victim; it revisits the internal trauma that causes spiritual pain and discomfort, allowing creative energies to emerge instead Figure 1.
In overloading, the tendency is to quit : this results from the crisis of performance anxiety and professional incompetency; the pain of the depleted self and depleted performer. Healing implies treatment and medication. In overexposure one wants to ' rest' and to ' retreat' spiritual repurposing : this results from the emotional exhaustion of professional competency: the pain of the depleted helper and depleted co-sufferer. Healing implies debriefing and group sharing to be interconnected to other caregivers in the field as well as a reassessment of existing God-images.
In vicarious traumatisation one wants to revisit and reframe one's paradigmatic framework of interpretation.
Healing implies a re-assessment of the appropriateness of the theory behind the caregiver's engagement in order to change meaning. What should be made clear at this point is that resulting from the interconnectedness of the three issues at stake, compassion fatigue develops over a period of time and, as a process, can be manifested in different ways. The hermeneutics of compassion fatigue: Seeing the bigger picture within a process of understanding. Without any doubt, compassion fatigue is a process category Figley As a process category, compassion fatigue consists of the following:.
A constant awareness of a very specific event or tragedy that acted as a kind of trigger factor. An overexposure to suffering on a constant and continuous daily or weekly scale. Empathy is triggered by an external factor making an appeal on one's compassion. The existence of an intensified empathetic ability sensitivity to notice the pain of the other compassion compulsion. An empathetic response: an ability to detect suffering to the extent that the helper makes an effort to diminish the suffering of the sufferer.
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Disengagement and differentiation: this refers to the ability of the helper to distance him or herself from the continuous misery experienced by the traumatised person. Sense of satisfaction: this refers to the sense of achievement the helper feels resulting from his or her efforts to help the person in need.
Residual compassion stress: this refers to the compulsive demand for action in order to relieve the suffering of others. Prolonged exposure: this component of the process refers to the on-going sense of responsibility to care for the sufferer. Normally it takes place over an extended period of time it describes a kind of cumulative result of internalising the helplessness of the other. Traumatic memories: the trauma of unexpected tragedy and irreparable loss triggers guilt and shame. It even underlines the failure to cope or to help in an efficient way.
Other life demands: there are many other issues making an appeal on one's compassion. Unexpected changes that occur in schedules, routines and managing life responsibilities, that demand our attention, bring about an intensified awareness of capacity and ability. Vicarious traumatisation: the transfer of the predicament of the sufferer's pain infiltrates the caregiver's framework of reference to such an extent that the healer's convictions become disrupted and confused. This results from the fact that the suffering or pain of the other makes an appeal on one's suffering-with and on behalf of the other.
Internally doubt and a kind of inner nausea and resistance against the nonsense of suffering in general develops. The internal conceptual and cognitive framework is exposed as being inappropriate in terms of the sustainability of the caregiver's compassion. The following diagnostic diagram gives a depiction of compassion fatigue as a cumulative process.
The wear and tear of compassion in caregiving does not develop instantly and suddenly. It develops often over several years and as a result of constant and continuous exposure to suffering Figure 2. Compassion satisfaction. Compassion fatigue should be understood in close connection to the indicators for efficiency in caregiving. To act according to the expectations of one's caregiving profession, and in the light of the character of one's pastoral identity, as well as a clear theoretical framework for the field and discipline of pastoral care, leads to experiences of 'satisfaction' an awareness of appropriateness and competency.
Coherence between theory and praxis enhances compassion satisfaction. Congruency between the caregiver and his or her pastoral commitments also add to experiences of compassion satisfaction. Satisfaction is determined by the following:. Efficacy: How efficient is my input? Beneficiary: How beneficial is the helping relationship? Did the person benefit? Healing: Did the helping relationship instigate change?
Did it make any difference result? Experience of fulfilment: Do I have a feeling of being content with my work success. Constructive feedback: The experience of being competent and acknowledged by peers in the field. Satisfaction in pastoral ministry should be assessed in close connection to a sense of vocation and calling.
The burning question is then: To what extent is the caregiver motivated by a personal calling of God to a ministry of compassion? Is my passion merely based on emotions or directed by a clear image of God and the interplay between divine presence and a theology of compassion? Coping with the reality of compassion fatigue.
The fact is that caregivers should acknowledge that compassion fatigue is a 'normal reaction' to the suffering of the other in the attempt to help and is not necessarily 'abnormal' in the sense of sever pathology. The process of understanding the differentiation between burnout, compassion fatigue and vicarious traumatisation, is part of 'managing' the phenomenon. The following coping steps should be taken into consideration:. Acknowledge the phenomenon and differentiate between the other features of spiritual stress.
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Compare the negative cost of caregiving against the background of possible positive gain and possible credits: the dynamics of loss and gain. Exercising unconditional love: this is the opportunity to care without expectation of any form of compensation; this is the dynamics of love and sacrifice. Sacrifice without an understanding of the ethos of unconditional love and mercy, becomes the unbearable trauma of vicarious suffering.
Contribution to well-being and healing within the realm of human suffering: This is the dynamics of quality mode and quantity numbers ; ability and limitation. Invest in human dignity irrespective of possible outcome and results: to care and to help are to dignify humans; this involves the dynamics of life and death. The perception of pastoral caregiving as an opportunity to integrate theory with practice; this is the dynamics of skills and integrity.
Exposure to suffering should be used as an opportunity to enrich one's life; achieve a sense of life-fulfilment; the dynamics of vocation commitment and profession career or job and duty. The spiritual healing of the wounded healer: Prevention is better than cure. The remark has been made that instead of attempting to merely quit, there is the need in compassion fatigue to find a quiet place for reflection and debriefing.
Both the outer space of a retreat, as well as the inner space of an internal reflection on the meaning of compassion, is necessary. In order to heal the wounded healer, caregivers should keep in mind the two levels of compassion:. In this regard, the notion of a compassionate and suffering God Louw in theopaschitic theology can play a decisive role in the treatment of spiritual exhaustion.
In the processes of repurposing and reframing attention this should be given the role of a divine compassion in caring ta splanchna, oiktirmos. One should acknowledge that compassion refers to both empathy feeling with and sympathy being-with. Compassion, resulting from empathy, is the attempt on an affective level to probe into the framework of reference of the other.
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