Therapists Need to Engage in Self-Care to Prevent Compassion Fatigue

An important issue I believe psychologists, counselors, social workers and others in “helping” professions need to stay mindful of is something called “compassion fatigue.”  I know, personally, I have always believed that I do a pretty good job of compartmentalizing the stories of trauma and tragedy I hear every day in working with my clients from the other aspects of my life, but I’m starting to believe more and more that those of us in the helping professions need to always be mindful of the need for “self-care” and to be deliberate in taking steps on a regular basis to engage in “self-care” to prevent the emotionally demanding nature of the work from taking a toll on our physical, emotional, and mental well being.

Compassion Fatigue was described by Figley in 1995 as “a state of exhaustion and dysfunction – biologically, psychologically, and socially – as a result of prolonged exposure to compassion stress.” He also stated that compassion fatigue is “identical to secondary traumatic stress disorder (STSD) and is the equivalent of PTSD.” Within professional literature, compassion fatigue is also known as secondary traumatization or vicarious traumatization (Figley, 1995 and McCann and Saakvitne, 1995, as cited by Simpson and Starkey, 2006).

The things we in the helping professions need to do for self-care and to prevent compassion fatigue are the same things we tell our clients to do to take care of themselves.  We need to make sure we are taking our own advice.  We need to make a concerted effort to keep ourselves in good shape by doing things like exercise, yoga, meditation, eating right, getting enough sleep, and regularly engaging with professional and personal friends. It might be important to engage in supervision or consultation with a colleague and maybe even to enter therapy for yourself to process the tough aspects of your work. Taking up a new hobby or doing creative activities such as drawing, painting, photography, scrapbooking, etc. may also help to give you a boost. Spirituality also seems to play a central role in how well an individual manages the symptoms of compassion fatigue (Simpson and Starkey, 2006). We also need to take vacations and days off as needed—unplugging from cell phones and e-mail—to refresh and recharge.

Despite the emotionally demanding nature of the work I do, I am reminded every day of how blessed I am to have the opportunity to work with the clients I do and am uplifted and re-energized by their determination to persevere in the face of many obstacles and challenges and to improve their lives.

DSM-5 to be released in May 2013

A highly anticipated event in the mental health field in the upcoming release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is anticipated that the DSM-5 will be released by the American Psychiatric Association in May 2013. The DSM-IV, which is currently used to diagnose psychiatric disorders, was released in 2000. As noted in “Psychiatric News” in February 2012, one of the biggest and likely most controversial changes from the DSM-IV to the DSM-5 will be the elimination of the diagnoses of Autistic Disorder (Autism), Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS). It was reported in “Psychiatric News” that “a new category, Social Communication Disorder, is proposed to capture patients who exhibit autism-like impairments in social communication but without repetitive and restrictive behaviors. These patients have typically been diagnosed with PDD NOS. A single diagnostic entity— Autism Spectrum Disorder—is being proposed for inclusion in DSM-5 as a replacement” for Autistic Disorder (Autism), Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS) listed in the DSM-IV. Other major changes include the addition of several language-related disorders and a category to be called “Specific Learning Disorder” with seven “descriptive feature specifiers” that would be used by clinicians in the diagnosis of clients with learning disorders in specific areas.

Six Success Attributes for Individuals with Learning Disabilities

I see many clients who have learning disabilities, and while some of them unfortunately “slipped through the cracks” in school, not receiving the extra one-on-one help and other resources they needed to succeed academically, there are those who have achieved great success in their academic and career pursuits due to hard work and the support of amazing parents and teachers over the years.  Maybe the individuals in the latter group developed some or all of the six success attributes for individuals with learning disabilities that I recently read about on the website,

In Life Success for Children with Learning Disabilities: A Parent Guide by Marshall Raskind, Ph.D., Roberta Goldberg, Ph.D., Eleanor Higgins, Ph.D., and Kenneth Herman, Ph.D. at the Frostig Center in Pasadena, California, the following six success attributes were identified as those that successful individuals with learning disabilities are much more likely to have than individuals with learning disabilities who are not successful:  self-awareness, proactivity, perseverance, goal-setting, the presence and use of effective support systems, and emotional coping strategies.  Self-awareness is being aware of your learning problems and how they affect your life but also recognizing that your learning problems are only one aspect of yourself.  Proactivity is believing you have the power to control your own destiny and affect the outcome of your life– not taking a passive stance.  For example, a student with a learning disability who demonstrates the willingness to meet with her instructors before and during each semester to get extra help as needed is likely to achieve greater success in college than a student with a learning disability who does not demonstrate such initiative and proactivity.

Individuals with learning difficulties who demonstrate perseverance keep working toward their goals despite difficulties.  However, Drs. Raskind, Goldberg, Higgins, and Herman point out that successful individuals with learning disabilities also possess the ability to know when to quit.  Sometimes an individual has to be flexible and try several strategies until he finds one that works.  Successful individuals with learning disabilities also engage in goal-setting.  They set specific, yet flexible, goals that are realistic and attainable.  The presence and use of effective support systems also contribute to the success of individuals with learning disabilities.  According to Drs. Raskind, Goldberg, Higgins, and Herman, successful individuals with learning disabilities tend to have people in their lives who “held clear and realistic expectations regarding life goals and outcomes, guiding them to identify and achieve realistic goals without being harsh or critical.”  Moreover, they actively seek support and accept it when it is offered.  Lastly, successful individuals with learning disabilities use emotional coping strategies to prevent becoming overwhelmed and stressed.  These coping strategies include expressing one’s feelings, asserting oneself, planning ahead for difficult situations, obtaining medication and/or counseling if necessary, etc.

Cultivating the success attributes is one of the ways that parents of individuals with learning disabilities can help them grow up to be successful throughout their lives.  Drs. Raskind, Goldberg, Higgins, and Herman pointed out that “these attitudes, behaviors, and characteristics require exercise, practice, and review just like any other skill children learn. At different life stages, new developmentally appropriate challenges may require parents to recycle and revisit with their children the success attributes they had worked on earlier.”

Trauma and Psychological Assessment

Dana Grote, Ph.D.

I attended a wonderful conference last Friday that was hosted by the Colorado Assessment Society called “Exploring the Landscape of Trauma with Psychological Assessment” that was presented by Judith Armstrong, Ph.D. Dr. Armstrong has worked for many years in the assessment and treatment of individuals with severe psychological trauma and dissociation. She contributed to the creation of the Adolescent Dissociative Experiences Scale (A-DES), Rorschach Trauma Content Index (TC/R), and the Dissociative Behavior Checklist (DBC-II).

Dr. Armstrong stressed that trauma changes the emotional and meaning systems of a person. She described protective factors that help a person deal with a traumatic event in the healthiest way possible, including having a supportive social network, “lucky” heredity, a healthy attachment history, and “approach coping” (i.e., the mentality that if you’re knocked off the horse, you get back on it). According to Dr. Armstrong, there are also risk factors that can hinder one’s ability to deal with trauma. These risk factors include pre-existing psychological problems (psychopathology), “unlucky” heredity, and “avoidant coping.” Avoidant coping occurs when there is denial about the traumatic event (e.g., “Everything’s fine…I’ve dealt with it”). Another risk factor is when the trauma becomes central to the person’s self-definition (i.e., the person views him/herself as a victim).

Dr. Armstrong mentioned the work of Bessel van der Kolk, M.D., who has been active in the area of posttraumatic stress since the 1970’s. Dr. van der Kolk talks about how “the body keeps score,” meaning that trauma resides in the body and that the body can “hold” emotions even when the mind cannot. A person can experience “body flashbacks,” such as experiencing shoulder pain while talking about being pinned down during a rape. Dr. Armstrong talked about trauma can lead to smaller cerebral (brain) size in children.

Something I found very interesting in Dr. Armstrong’s presentation is the notion of “traumatic wisdom.” She explained that a person who has been exposed to trauma can take what he/she learned from dealing with the traumatic event and put it into action in a positive way. For example, if love has been “turned off” in one area, say from neglectful and/or abusive parents, it can be “turned on” in a love for nature or animals. Moreover, the opposite of “survivor guilt” – “survivor pride” – can develop in that the person has a sense of confidence as a result of the trauma (e.g., “If I can make it through that, I can make it through anything”). I really liked a quote she mentioned (author unknown): “Happiness is not a state of being. Happiness is a state of overcoming unhappiness.” I thought this quote really summed up how many individuals arrive at a state of happiness following trauma.

Dr. Armstrong discussed how psychological assessment can be a teaching process for clients. She asks clients at the outset of an evaluation, “What is your most pressing question?” and “What are you afraid you will find out as a result of the evaluation?” She uses Therapeutic Assessment, which was developed by Stephen Finn, Ph.D. and his colleagues at the Center for Therapeutic Assessment in Austin, Texas. For more information about Therapeutic Assessment, please check out this website:

Dr. Grote holds a Bachelor of Science degree in Psychology from Colorado State University (1995) and Master of Arts and Doctor of Philosophy degrees in Clinical Psychology from the University of Detroit Mercy (1998/2000).  She is a licensed clinical psychologist who conducts psychological evaluations for clients with learning and developmental disabilities and psychiatric disorders.  She also has experience in neuropsychology, cognitive rehabilitation, and working with clients with mild traumatic brain injuries.  Dr. Grote is a native of Colorado and married with two children.  In her spare time, she enjoys traveling, skiing, volunteering, and spending time with friends and family. 

E-mail Dr. Grote or call extension 104 for information about consultation services, learning disability and psychological evaluation, and therapy for people with disabilities.

What do intelligence tests measure?

WAIS-IVThe most current version of the Wechsler Adult Intelligence Scale, the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), is considered the gold standard in psychological assessment for measuring cognitive or intellectual ability. The Full Scale IQ score, in most cases, best estimates a person’s overall cognitive ability. However, when there is a significant difference between a person’s verbal reasoning abilities and his/her nonverbal reasoning abilities, the Full Scale IQ may not be considered the best estimate of the person’s overall cognitive ability. Verbal reasoning abilities are measured by the Verbal Comprehension Index, which at the core assesses a person’s knowledge of word meanings, verbal abstract reasoning, and knowledge of world facts. The core nonverbal reasoning subtests measure one’s ability to solve visual puzzles that are “hands on” or purely visual–with and without time limits. The Working Memory Index measures the ability to store and manipulate auditory information in short-term memory, while the Processing Speed Index measures the speed at which a person accurately processes visual information. Immediate feedback about one’s test performance is not provided during testing.

In addition to the responses a person provides during testing, the way a person approaches the testing situation is also important. Some people get easily frustrated and give up quickly on difficult items, while other people persist on difficult tasks and ask to keep working past the time limit. Some people become emotional during testing, voicing embarrassment or shame about their performance, while others take their perceived shortcomings in stride and maintain a sense of humor. Some individuals discover strengths they never realized they had, such as nonverbal reasoning in solving visual puzzles, which may not have been tapped much in school.

The WAIS-IV was introduced by Pearson Assessments in 2008. It is designed to be used with people between the ages of  16 and 90. The Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) is used with children between age 2 years, 6 months and 7 years, 3 months.  The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) can be used with children between age 6 and age 16 years, 11 months.

Dr. Grote holds a Bachelor of Science degree in Psychology from Colorado State University (1995) and Master of Arts and Doctor of Philosophy degrees in Clinical Psychology from the University of Detroit Mercy (1998/2000).  She is a licensed clinical psychologist who conducts psychological evaluations for clients with learning and developmental disabilities and psychiatric disorders.  She also has experience in neuropsychology, cognitive rehabilitation, and working with clients with mild traumatic brain injuries.  Dr. Grote is a native of Colorado and married with two children.  In her spare time, she enjoys traveling, skiing, volunteering, and spending time with friends and family.

Finding Work After a Brain Injury

By Gregory Ayotte, Director of Consumer Services, Brain Injury Association of America (BIAA)

In working with many clients who have an invisible disability (e.g., a brain injury, learning disability, psychiatric disorder, etc.), I know how difficult it can be for a person with an invisible disability to function day-to-day – wondering if he/she should disclose his/her disability, and if so, how it will be perceived.  Will the other person – maybe a potential employer – understand the difficulties you face because of your disability and what accommodations might be available to you to “level the playing field” and maximize your chances for success?

Below you will see the response Gregory Ayotte, Director of Consumer Services at the Brain Injury Association of America (BIAA), gave to a person who sustained a brain injury in an accident during high school.  This person has no experience in the workplace and is having difficulty obtaining a job without prior work experience.  Mr. Ayotte provided the following advice:

“I would encourage you to start your journey by contacting the Brain Injury Association office in your state. The Brain Injury Association of America’s nationwide network of chartered state affiliates ( provide direct support, information, resources, education and advocacy for individuals living with brain injury (BI); their friends and family; professionals who provide research, treatment and services; and the general public.


Resources for Entrepreneurs with Disabilities

(By Penny Pickett, Associate Administrator for Entrepreneurial Development, U.S. Small Business Administration)

More and more Americans with disabilities are going into business for themselves. In fact, according to the U.S. Census Bureau, people with disabilities are almost twice as likely as individuals without disabilities to start a business.  For many Americans with disabilities, self-employment can offer empowerment, control and the flexibility to succeed. Home-based businesses in particular can accommodate an individual’s unique needs in a way that a more traditional corporate workplace may not.  As for all entrepreneurs, starting and managing a business as an individual with a disability is a significant undertaking – not only for one’s finances, but for maintaining one’s agility, stamina and determination.

Considering Entrepreneurship?
Building a business as a person with a disability presents unique challenges. For example, the potential loss of benefits that an established employer provides can be a significant hurdle to starting your own business.  Despite these challenges, the success rate among small business owners with disabilities is unprecedented. The Disabled Businesspersons Association, for example, estimates that 40 percent of home-based businesses are operated by people with disabilities.  To keep this percentage on the uptick, there are many government and government-sponsored programs to assist those with disabilities in starting, operating and growing a business.  Below is a summary of some useful resources for small business owners with disabilities, including business and market development advice, financial programs and business operation information.

Resources for Individuals with Disabilities Interested in Starting a Business
If you have a disability and are considering starting your own business, there are several in-person or Web-based resources available to you.

  • The U.S. Small Business Administration’s (SBA) Business Resources for People with Disabilities web page provides online access to a wide variety of resources that help individuals with disabilities start, grow and manage a small business. The site includes online seminars, links to relevant self-employment information specifically for those with disabilities, as well as guides that introduce and address critical issues for entrepreneurs with disabilities.
  • also links to other agencies and organizations such as Start-Up USA (which is sponsored by the U.S. Department of Labor) and the Social Security Administration’s Ticket to Work Program that can help you use benefits funding to achieve vocational goals through training programs. also provides step by step information on how to start a small business.
  • At the U.S. Department of Labor, the Office of Disability Employment Policy’s (ODEP) Job Accommodation Network (JAN) provides individualized technical assistance, consulting and mentoring services to budding entrepreneurs with disabilities, family members and service providers. You can call JAN consultants for individual assistance regarding all aspects of entrepreneurship. JAN’s services are available free of charge through their toll-free numbers: (800) 526-7234 or (877) 781-9403 (TTY) or 1-800-232-9675/voice/TTY


Higher education institutions report increase of students with learning disabilities

From the Learning Disability Association’s  ( LD Source:

College and other post-secondary enrollments of students with disabilities continue to rise in the United States — with 88 percent of the institutions reporting enrolling students with disabilities in the 2008-09 academic year. About 707,000 students with disabilities were included in the reports. Of those enrolling at higher education institutions, 86 percent had some kind of specific learning disability. More