Ethics of self care

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Management of self-care includes preventive measures important for avoiding burnout or compassion fatigue. Helpers can struggle with keeping a balance between care for others and care for themselves. Review Exercise 14.2, the Self-Care Worksheet, in your textbook.

In your initial post, discuss one of the items in each domain (physical health, social connections, psychological domain, affective domain, inner life, professional domain) that you engage in regularly and explain how that activity helps you maintain balance in your professional and personal life.

347

C H A P T E R 14

Competence and
the Ethics of Self-Care

I don’t know if it is I’m just overworked or whatever. I’m having
trouble sleeping, don’t want to do anything or go out with friends,
and truthfully, I look at my appointment schedule and start hoping
clients cancel. I’m not sure what’s up, but I sometimes wonder if it’s
time to simply get out of this profession?

T
he experience being described by the human service provider who
opened this chapter is sadly neither unique to this profession nor
that unusual. For all who work as human service providers, the

mental fatigue and emotional exhaustion that accompany the intense work
we do can be destructive to our health, mental well-being, and ability to
provide ethical and effective service to our clients.

Table 14.1 highlights the fact that our professional codes of ethics are
clear in their mandating of professional competence as a primary ethical
requisite to providing service.

As suggested in the codes posted (see Table 14.1), the primary focus
rests on competence as defined by one’s knowledge, skill, and experience.
While these are clearly essential to effective, ethical practice, they are not
the only considerations that should be made when assessing one’s ability or
one’s competency to perform professional service.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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348–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Table 14.1 Addressing Competency

Professional
Organization Principle

American Counseling
Association (2014)

C.2.a. Counselors practice only within the boundaries of their
competence, based on their education, training, supervised
experience, state and national professional credentials, and
appropriate professional experience.

American Psychological
Association (2010)

2.01.a. Psychologists provide services, teach, and conduct
research with populations and in areas only within the
boundaries of their competence, based on their education,
training, supervised experience, consultation, study, or
professional experience.

American Association
for Marriage and Family
Therapy (2015)

Standard III. Marriage and family therapists maintain high
standards of professional competence and integrity.

International
Association for Group
Psychotherapy and
Group Processes (2009)

Principle 3. Group psychotherapists who are members of
the IAGP should have either completed formal education in
group psychotherapy or be presently receiving supervision in
an ongoing educational program by an established training
organization that meets specific requirements.

National Association of
Social Workers (2008)

1.04. a. Social workers should provide services and represent
themselves as competent only within the boundaries of their
education, training, license, certification, consultation received,
supervised experience, or other relevant professional experience.

The current chapter reviews the ethical principles of provider compe-
tence with special emphasis on the threats to competency emanating from
the experience of burnout and compassion fatigue.

● OBJECTIVES

As such, the current chapter will help you to

• Describe what is meant by burnout and compassion fatigue
• Explain the difference between burnout and compassion fatigue
• Describe the ethical challenges burnout and compassion fatigue pres-

ent for the human service provider

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–349

• Identify ways a human service provider can reduce the possibility of
burnout and compassion fatigue

• Articulate a personal wellness plan

COMPETENCY: MORE THAN KNOWLEDGE AND SKILL ●

In their book, Field Experience: Transitioning From Student to Profes-
sional, Zhang and Parsons (2016) introduced the concept of self-care with
an Anton Wildgans’s (1881–1932) quote, which has been made famous by
Viktor Frankl, the author of Man’s Search for Meaning (1963): “What is to
give light must endure burning.” While Wildgans’s quote is clearly reflective
of his own experience as a provider of care and support to self and others
during the Holocaust, the simple quote speaks volumes for all human service
providers who have been engaged in providing care and support to others.

Perhaps, you are just starting your training in the field or are coming to
the end of your training. In either case, it is likely you have already experi-
ence the awesome gift and responsibility of serving in the role of human
service provider. Being invited to journey with another, especially during a
time of turmoil and challenge, demands knowledge and skill of the helping
process, awareness of that which constitutes “best practice,” and the physi-
cal and emotional energy to engage in a dynamic and challenging therapeu-
tic relationship. They are responsibilities that provide light, while at the
same time opening the provider to the possibility of emotional “burning.”

Helping: Being With, Not Doing To

Unique to the role and function of a human service provider is the fact
that we are required to “walk with” our clients and not simply do for them.
Our clients are not cogs on a conveyor belt needing to be assembled, nor
are we simply information providers to those requesting direction. Our cli-
ents are those navigating through a challenging time in their lives, for whom
support, emotional, social and physical, is required.

As human service providers, we are engaged in a service that requires
our personal, emotional engagement with the client (Bakker, Van der Zee,
Lewig, & Dollard, 2006). The very process of engaging with others who are
suffering can pose a threat to the human service provider (O’Brien, 2011).
The work we do is fertile ground for stress. The fact that we work in situa-
tions of physical and social isolation, where we often encounter unexpected
and unpredictable schedules and demands and by definition immerse

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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350–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

ourselves in intense personal interactions, provides the conditions to make
this work stressful and emotionally demanding (Bakker et al., 2006). The
stress of taking on the responsibility for assisting one in crisis, especially
when work conditions are such as to add to that stress or, conversely, fail
to provide the essential support necessary for providing ethical, effective
service, can accumulate and will negatively impact the provider’s ability
to perform competently. Research would suggest that those engaged in
the helping professions are vulnerable to effects of enduring stress (Lee
et al., 2007).

Given the nature of our work it is not unexpected to find that many find
it difficult to maintain their own health and well-being. According to a study
by the American Counseling Association (ACA, 2010), of those surveyed,
over 63 percent reported knowing a colleague whom they would consider
impaired. The magnitude of the finding moved the ACA to develop a task
force for the sole purpose of decreasing impairment and enhancing wellness
among its members.

The impact of enduring stress and the toll it can take on both the pro-
fessional and the clients whom they serve makes it a clear ethical concern.
While the impact of enduring stress can take many forms, two—burnout and
compassion fatigue—are the focus of the remainder of this chapter.

● BURNOUT

Burnout has been described as the “gradually intensifying pattern of physi-
cal, psychological and behavioral responses to a continual flow of stressors”
(Gladding, 2011, p. 24). Burnout is experienced as emotional exhaustion
and often manifests in form of apathy, negative job attitude, and perhaps
most concerning from an ethical perspective of competence, a loss of con-
cern and feeling for the client (Gladding, 2011).

For some practitioners experiencing burnout, the impact is evident
in their tendency to withdraw from social contact, become defensive and
aggressive in relationships, and when it comes to clients, exhibit a dehu-
manizing attitude (Lambie, 2002). That dehumanization often reveals itself
in the provider’s identification of clients by a diagnostic label such as “my
borderline” or in personal characteristics, for example, the “divorcee,” and
serves to distance and detach the counselor from the person of the client
and thus his or her suffering (Maslach, Schaufeli & Leiter, 2001). Consider
the case of Dr. L., one practitioner for whom burnout clearly impacted her
ability to provide effective, ethical service (Case Illustration 14.1).

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–351

Case Illustration 14.1

Dr. L.: A Case of Burnout

Dr. L. is a 48-year-old clinical psychologist working in a community
mental health center. She has worked as a clinician for over 19 years
and has been employed within this center over the past 8 years. Over
the course of the past 8 years, she has experienced a decline in both
professional and support staff, while at the same time an increase in
both the number of clients seen and the level of severity of the issues
being presented. The pressure from external funding sources as well
as internal administration placed emphasis on a mandate to see more
clients and produce results with fewer sessions. The increased workload
resulted in her working late hours, often 10 hour days, and twice a
month being required to work a sixth day, Saturday, to increase her
“productivity” figures.

The physical exhaustion of the increased workload, the reduction
of physical and emotional support, and a general dissatisfaction and
discomfort with what she saw as her inability to provide “adequate”
service began to take its toll. As one who considered her work more
than a job, a true vocation, the situation left her feeling professionally
inadequate.

While these changes developed slowly, it became obvious that Dr.
L. was experiencing a deep sadness and a lack of interest in engaging
in previously enjoyable activities (e.g., racquet ball, golf, etc.). She was
finding it difficult to make decisions within her practice, even to the
point of failing to develop meaningful treatment plans for her clients.
Dr. L. reported a concern that her ability to attend to her clients seemed
diminished and that she had on occasion experienced moments when
her memory went “blank.” She reported entering sessions in which she
brought the wrong case file and even had three occasions where she
either could not remember the client’s name or referred to the client by
using another client’s name.

She found the experience to be such that she “dreaded” going to
work and hoped that clients would cancel. In addition, she began call-
ing out and taking sick days, often canceling appointments at the last
moment. While her colleagues privately expressed concern, no one
reached out to Dr. L. Fortunately, her diminishing level of professional

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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352–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

As is evident in our case illustration, the experience of burnout is
multidimensional. In addition to somatic and cognitive symptoms, burnout
can affect a professional’s emotional stability, resulting in conditions rang-
ing from annoyance and frustration to more severe presentations, such as
depression and anxiety (Maslach, Schaufeli, & Leiter, 2001). For others,
burnout results in apathy, fatigue, anger, and conflict (Gladding, 2011). In
any presentation, it becomes clear that burnout will impair one’s ability to
provide ethical care and service (Maslach, 1993).

effectiveness along with her increased reliance on alcohol as a means
of self-soothing led Dr. L to ask for, and receive, medical leave.

While her break from work was brief, only two weeks, it was a time
when, with reflection and discussion with a supervisor, Dr. L gained
insight into what she was experiencing and the steps she needed to
take to engage in her own healing. After this break, during which time
she returned to a regimen of healthy eating, regular exercise, engage-
ment with friends, and getting 7 to 8 hours of sleep each night, her
symptoms diminished and she found not only a desire to return to her
clients but also an energy and enthusiasm to advocate organizational
changes in order to bring their services in line with that expected of an
ethical, effective center.

(Continued)

● COMPASSION FATIGUE

A hallmark of the both the helping relationship and the role of the human
service provider is our ability to enter into the other’s phenomenological
field, experiencing their world as they do, sharing their feelings, and better
understanding their world and self-views. This ability to experience deep
empathy is both a gift and a potential risk. Sharing in the pain, the anxiety,
the sadness, or the sense of hopelessness often presented by our clients can
challenge our ability to balance professional objectivity and distance while
at the same time truly walking with our client. For clinicians lost in the lived
experience of their clients, the result can be quite destructive, leading to
increased stress and an inability to continue to feel and convey the compas-
sion so characteristic of the helping professions.

Compassion fatigue has been defined as a “state of exhaustion and
dysfunction—biologically, psychologically, and socially—as a result of

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–353

prolonged exposure to compassion stress (Figley, 1995, p. 253). Compassion
fatigue differs from burnout in that it occurs suddenly, rather than gradually
as is the case with burnout, and presents often with symptoms that mirror
post-traumatic disorders (Trippany, Wilcoxon, & Satcher, 2003). As such, it
is often referred to as secondary post-traumatic stress disorder.

The impact of compassion fatigue is both broad and deep. Compassion
fatigue can result in mental fatigue and an inability to concentrate, a deterio-
ration of one’s ability to work effectively, a change in a person’s fundamental
values and beliefs, and an increase in feelings of sadness, anxiety, and guilt
(Zhang & Parsons, 2016). In addition, for some, compassion fatigue results
in excessive emotional numbing and, like those with post-traumatic stress
syndrome, the experience of intrusive images and thoughts of their cli-
ent’s traumatic material. This experience can reduce the clinician’s ability
to empathically engage with a client and thus presents a very real threat to
one’s ability to provide competent, ethical service.

THE ETHICAL CHALLENGE ●

Burnout and compassion fatigue must be recognized and accepted as real
threats to ethical practice. Consider the following case (Case Illustration 14.2)
as reflecting the unethical decisions and behavior that result from compassion
fatigue.

Case Illustration 14.2

Compassion Fatigue: Undermining Ethical Behavior

While serving as a middle school counselor for 18 years, Mr. E. had
spent the last 2 years working in the capacity of crisis interventionist.
In that role, he engaged with students who were physically and sexu-
ally abused, those exhibiting suicidal ideation and behavior, and oth-
ers with depression and debilitating anxieties. Now, halfway through
the academic year, he began experiencing a reduction of energy and
a loss of enthusiasm for his job. He began to exhibit attitudes and
behaviors that could best be described as atypical for him and clearly
unprofessional.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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354–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

It would be easy to dismiss both compassion fatigue and burnout as
things that happen to those who have worked “too long” in the field. How-
ever, failing to embrace the reality of burnout and compassion fatigue as
real possibilities for ourselves, regardless of our tenure within the profes-
sion, positions us to engage in unethical behavior (Everall & Paulson, 2004).
These conditions not only attack the professional’s physical stamina but also
as detailed above result in psychological exhaustion, emotional distress, and
potential exploitation of clients (Norcross, 2000), and they can occur at any
stage of our professional life.

A Challenge to Core Values

A review of the core values that serve as the foundation of our codes of
ethics, values such as autonomy, beneficence, nonmaleficence, and justice

Whereas students historically sought out his service and support and
parents spoke highly of his effectiveness and real care for the students, it
was clear by student complaints about his lack of availability and tendency
to be sarcastic when interacting with them that something was changing.
Even faculty began to report on the apparent changes in his demeanor and
professional behavior, noting that something was negatively impacting his
ability to function in his role as crisis intervention counselor.

Faculty reported experiencing his increased venting and complain-
ing about the students he was seeing. They noted that he often referred
to the students and their life conditions as hopeless and that he, as one
person, was impotent in “rescuing” them from the “hands they were
dealt.” While concerned about the apparent heavy heart he exhibited
when speaking of some of the students, the faculty were equally con-
cerned by what appeared to be his angry, dismissive, and devaluing
attitude toward other students. Faculty reported hearing him use inap-
propriate terms, such as referring to some students as “diagnosable”
or others as falling into the category of “P.I.T.A.” (pains in the ass). The
dismissiveness and depersonalization was even experienced by teach-
ers seeking consultation who were told to “do their own damn jobs.”

While certainly unprofessional, the language and labeling was so
out of character for Mr. E., a person who had previously been a model
of caring and professionalism, that faculty went to the district supervisor
to report their concerns.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–355

(See Chapter 3), illuminates the ethical challenge presented when a practi-
tioner is experiencing burnout and/or compassion fatigue.

As ethical providers, we are directed to respect and attend to the
welfare of our clients. Respecting the integrity of those with whom we
work, committing to serving their welfare, and engaging in competent best
practice are principles found across our professional codes of ethics. For
example, the American Psychological Association (APA, 2010) notes that
psychologists, embodying the values of beneficence and nonmaleficence
“strive to benefit those with whom they work and take care to do no harm.
In their professional actions, psychologists seek to safeguard the welfare
and rights of those with whom they interact professionally” (Principle A).
Consider this standard in light of the two previous case illustrations (i.e.,
Case Illustrations 14.1, 14.2). Certainly, meeting this ethical standard and
the similar standards expressed by the other professional human service
organization is difficult, if not impossible, when one is experiencing burn-
out and/or compassion fatigue.

A Challenge to Developing and Maintaining
an Ethical Therapeutic Relationship

As noted by Everall & Paulson (2004), a counselor who is having diffi-
culty meeting her personal needs appropriately may violate boundaries and
become more deeply enmeshed with her clients. The physical, psychologi-
cal, and emotional exhaustion that accompanies burnout and compassion
fatigue can result in the human service provider disengaging from the client
to a point of negating the client as person and not only demonstrating the
inability to maintain a sense of empathy but even a basic respect for the
client. Since responsible caring requires professionals to actively demon-
strate a concern for the welfare of individuals, the practitioner’s diminished
ability to function as a result of burnout or compassion fatigue may con-
stitute a serious violation of a fundamental principle of ethical practice.
Further, with a personal sense of exhaustion, a human service provider not
only runs the risk of failing to engage and maintain a therapeutic alliance
but also runs the risk of aligning with a client’s feelings of frustration, anger,
and hopelessness to the point of conveying a doubt in the effectiveness of
their service. Under these conditions, the practitioner risks exploiting the
client through boundary violations or role reversal in order to meet personal
needs.

Disengagement from one’s client or using clients to meet personal
needs clearly violates the primary directive to respect the dignity and
promote the welfare of our clients (e.g., ACA, 2015, Principal A.1.a;

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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356–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

AMHCA, 2010, Principle I.A.1.a). The inability to care and respect truly
undermines one’s competence to engage in effective therapeutic rela-
tionships and as such is a violation of our ethical principles. For those
experiencing the inability to perform competently because of burnout
and/or compassion fatigue, the directive, as noted the APA, is to “refrain
from initiating an activity when they know or should know that there is
a substantial likelihood that their personal problems will prevent them
from performing their work-related activities in a competent manner”
(2010, Principle, 2.06).

A Challenge to Enacting Ethical,
Effective Treatment Plans

Engaging in ethical, effective treatment is a keystone of professional
practice. For example, the ACA directs its members to devise treatment
plans that offer reasonable promise of success (2014, Principle A.1.c). In
support of this principle, other organizations have directed practitioners
to continue to seek out on-going training and supervision as a means of
maintaining and upgrading competence. For example, social workers are
directed as follows:

[to] strive to become and remain proficient in professional prac-
tice and the performance of professional functions. Social workers
should critically examine and keep current with emerging knowledge
relevant to social work. Social workers should routinely review the
professional literature and participate in continuing education rel-
evant to social work practice and social work ethics. (NASW, 2008,
Principle 4.01)

Similarly, psychologists are ethically mandated to maintain competence
by undertaking “ongoing efforts to develop and maintain their competence”
(APA, 2010, Principle 2.03).

While it is notable that our professional organizations recognize the
need for the maintenance of a practitioner’s knowledge and skill as foun-
dational to competent service, it is equally important that we recognize
the fundamental need and value of maintaining a practitioner’s physical
and psycho-emotional well-being as equally foundational to competent
service. For example, the ACA not only calls for its members to maintain
knowledge of best practice and to devise treatment plans that offer a rea-
sonable promise of success but calls for its members to do so in concert

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Chapter 14. Competence and the Ethics of Self-Care –●–357

with their clients (ACA, 2014, Principle A.1.c). One may question how
such collaboration is developed and maintained when the practitioner
has disengaged and devalued the client as a result of his or her experi-
ence of burnout and compassion fatigue. Clearly, the disengagement
and devaluing of the client that often accompanies burnout and compas-
sion fatigue diminishes a practitioner’s interest and ability to effectively
engage with a client to devise, implement, and maintain an effective
treatment plan.

The reality of this challenge of enacting ethical effective treatment plans
has been noted across the profession and has been clearly articulated by
the ACA:

Counselors monitor themselves for signs of impairment from their own
physical, mental, or emotional problems and refrain from offering or
providing professional services when impaired. They seek assistance for
problems that reach the level of professional impairment, and, if neces-
sary, they limit, suspend, or terminate their professional responsibilities
until it is determined that they may safely resume their work. (2014,
Principle, C.2.g)

It is evident that effective, ethical practice is threatened when the
practitioner is experiencing burnout or compassion fatigue. As we close this
section of the chapter, we invite you to review Exercise 14.1. In the exercise
you are asked to reflect upon and perhaps discuss with a colleague, guiding
principles of ethical practice and how these may be impacted by the experi-
ence of burnout and/or compassion fatigue.

Exercise 14.1

Undermining Ethical Practice

Directions: Below you will find a listing of ethical principles found
across the spectrum of human service professions. Consider the multi-
dimensional impact that conditions such as burnout and compassion
fatigue can have on a human service provider’s ability to engage in
ethical practice and identify the specific threat these conditions pose
to the specific ethical principle listed. Share your reflections with a
colleague or supervisor.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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358–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

● ETHICAL RESPONSE

The possibility of encountering burnout and/or compassion fatigue in one’s
professional life presents the human service provider with two immediate
ethical challenges. The first one is understanding how one should respond
to the experience of either of these conditions, be that a personal experi-
ence or that of a colleague. Secondly and perhaps more importantly, the
human service provider is to be clear about what one should do to prevent
the experience of either of these conditions. Ignoring and/or denying the
possibility of a personal encounter with burnout and/or compassion fatigue
is neither practical nor ethical.

Preventative Measures: An Ethical
Response to Self-Care

In the best of all worlds, the human service provider will be insulated
from the possibility of burnout and/or compassion fatigue. However, human
service is by definition a form of one-way giving, therefore in the absence
of the practitioner’s emotional replenishment, he or she will soon run dry
(Skovholt, 2001).

Principle Burnout Empathy Fatigue

Promoting well-being/welfare
of the client

Establishing, maintaining
professional boundaries

Respecting client autonomy

Respecting client privacy

Providing competence service

Termination of service

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–359

Thus, while absolute protection and insulation from these conditions is
not possible, measures can be taken that will reduce the risk. Understanding
and implementing preventative measures as counteraction to the possibili-
ties of burnout and compassion fatigue is not only a rational response to
self-care but also truly an ethical one. As noted by Parsons & Zhang (2014),
“One cannot foster health and well-being in another if such is lacking in
oneself” (p. 284).

Self-care is essential to ethical, competent practice. The ethics of self-
care have been made clear by a number of our professional organizations.
The ACA, for example, directs counselors to “engage in self-care activi-
ties to maintain and promote their own emotional, physical, mental, and
spiritual well-being to best meet their professional responsibilities” (2014,
Introduction, Section C). Further, a review of the literature (e.g., Trippany,
White Kress, & Wilcoxon, 2004; Rupert & Kent, 2007; Ulman, 2008) high-
lights the importance of human service providers engaging in a program of
self-care, as protection from burnout and compassion fatigue. While there
are many ways one can care for self, those that have been identified as effec-
tive for intervening and preventing burnout and compassion fatigue involve
cognitive, emotional, and behavioral self-care strategies (Baird, 2008).

Exercise 14.2 lists a number of self-care strategies and invites you
to engage in a self-assessment. The hope is that engaging in this self-
assessment will result in your further commitment to your own self-care as
a way of strengthening your ability to engage in competent, ethical service.

Exercise 14.2

Self-Care Worksheet

Directions: Below is a list of activities that can contribute to one’s gen-
eral state of health and wellness and could prove valuable in lowering
one’s risk of compassion fatigue. Your task is to engage in an honest
self-assessment and plan for a commitment to a healthier lifestyle.
Identify at least one of the items of self-care that you feel you have
been lax in performing and commit to increasing your engagement
in that form of self-care starting immediately. It is suggested that you
repeat this process monthly as a way of promoting your own health
and wellness.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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360–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Domain Specific

I am
committed
to . . .

Physical
Health

Eating 4 to 6 meals a day

Eating well-balanced meals
including fruits and vegetables

Reducing sugar intake

Monitoring caffeine intake

Exercise: some form of exercise,
30 min at least three times a week

Dental care 2x annually

Consistent, sufficient sleep

Engage in enjoyable physical
activities: dance, swim, golf, bowl,
etc.

Other (your ideas)

Social
Connections

Go out with friends

Talk with friends and family

Visit family member/friend

Smile and say “hi” to those you
encounter in the course of your
typical day

Disengage from thoughts of clients
when in non-work social settings

Attend a group educational or
recreational experience (lecture,
concert, sporting event)

Connect with colleagues around
professional issues/questions and
concerns

Connect with colleagues around
nonprofessional issues/activities

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–361

Domain Specific

I am
committed
to . . .

Other (your choice)

Psychological
Domain

Engage in self-reflection

Read for recreation

Contract for personal counseling,
coaching, or spiritual direction

Increase awareness of personal
baggage and issues as well as
ways of managing them

Engage in stress-reduction activities

Employ anxiety-reduction techniques

Seek out opportunities to learn
and expand skill and knowledge
outside the professional realm
(e.g., learn foreign language or to
play an instrument)

Give permission and take the
opportunity to “zone” out as
a way of decompressing (e.g.,
watching television, playing a
video game, etc.)

Affective
Domain

Engage in activities that make you
laugh

Find opportunities to celebrate
“life” with others (e.g., birthday,
holidays, anniversaries)

Provide self with affirmation and praise

Freely express feelings of sadness
or loneliness (freedom to cry)

Reconnect via review of old
pictures or tapping memories of
loved ones and loving experiences

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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362–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Domain Specific

I am
committed
to . . .

Appropriately disclose feelings
of anger, frustration (rather than
repressing or displacing)

Sing like you can . . .

Dance like you wish . . .

Grant yourself permission to do or
attempt to do those activities you
always wished you could do

Other

Inner Life Engage in meditational readings

Engage in personal reflection

Meditate

Commune with nature

Participate in structured spiritual
activity (church service, prayer
group, retreat, etc.)

Engage with spiritual director or
mentor

Find opportunities for expressing
gratitude

Celebrate your gifts of life

Read about another’s spiritual
journey

Seek a moment, an opportunity to
be in awe

Other

Professional
Domain Set realistic daily task demands

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 14. Competence and the Ethics of Self-Care –●–363

Domain Specific

I am
committed
to . . .

Identity those tasks/activities that
are exciting and life giving and
integrate those with those activities
that tend to be more draining

Move away from the desk by way
of a simple break, a quick visit
with a colleague, or a short walk

Close your door to allow for quiet,
uninterrupted time to complete a
task

Say no to an invitation to do more
when you already have enough

Leave work issues and concerns
within the office

Engage in peer support around
client and case issues as well as
around personal questions and
concerns

Engage with a supervisor or mentor

Establish your work space so that
it feels both comfortable and
comforting

Set boundaries with colleagues,
especially when their interactions
are intrusions on your limited
time or when their requests are
overburdening

Take a moment to review your day
while identifying one aspect that
was professionally satisfying

Other

Source: Zhang, N. & Parsons, R. D. (2016). Field experience: Transitioning
student to professional. Thousand Oaks, CA: Sage. Reproduced with
permission of the authors.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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364–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Intervening in the Face of Burnout
and Compassion Fatigue

Even our best-laid plans will often fall short, and this is true for our
efforts to foster wellness. As such, it is possible that any one of us may
experience the effects of burnout or compassion fatigue somewhere in the
course of our professional life. When prevention is not possible, steps to
intervention will be key to our returning to effective practice. The steps
necessary are targeted not only to returning the professional to health and
well-being but also to protecting those with whom he works.

Awareness and Self-Care

As an initial step, it is our responsibility as professionals not only to
broaden our understanding of the impact that burnout and compassion
fatigue have on one’s ability to perform ethically and effectively but to moni-
tor our own health for signs of impairment. Norcross (2000) reported on
surveys of program directors and psychologists in which “self-awareness/
self-monitoring” was identified as the top-ranked contributor to optimal
functioning among psychologists. Such monitoring is not simply a “good”
idea but is truly an ethical mandate.

A useful tool for the monitoring of both burnout and compassion
fatigue is the Professional Quality of Life Scale (ProQOL) (Stamm, 2012).
The scale has been included in the section below, identified as “Coop-
erative Exercise.” It is provided as both a reference tool that can be used
throughout your career and an exercise in which you are invited to take a
snapshot of your current state of well-being. Whether one is a student or
engaged in a career, monitoring oneself for signs of impairment is an ethical
responsibility. The ACA, for example, directs both students and supervisees
to do the following:

Monitor themselves for signs of impairment from their own physical,
mental, or emotional problems and refrain from offering or providing
professional services when such impairment is likely to harm a client
or others. They notify their faculty and/or supervisors and seek assis-
tance for problems that reach the level of professional impairment,
and, if necessary, they limit, suspend, or terminate their professional

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 14. Competence and the Ethics of Self-Care –●–365

responsibilities until it is determined that they may safely resume
their work. (2014, Principle F.5)

Responding to Impairment

Our professional codes of ethics are clear in directing us to cease and
desist our engagement with clients once we become aware that we are com-
promised as professionals. The AMHCA, for example, directs its members to
do the following:

Recognize that their effectiveness is dependent on their own mental
and physical health. Should their involvement in any activity, or any
mental, emotional, or physical health problem, compromise sound
professional judgment and competency, they seek capable professional
assistance to determine whether to limit, suspend, or terminate services
to their clients. (2010, Principal C.1.h)

Similarly, counselors are directed by the ACA to “monitor themselves for
signs of impairment from their own physical, mental, or emotional problems
and refrain from offering or providing professional services when impaired.”
(2014, Principle C.2.g.)

Beyond refraining from practice, impaired human service providers
should, as noted by the AAMFT (2015), seek appropriate professional assis-
tance for issues that may impair work performance or clinical judgment
(2015, Principle 3.3). A point echoed by other professional organizations
(See Table 14.2)

Seeking and employing professional support is an essential ingredient to
the maintenance of the human service provider’s health and ability to per-
form ethically and effectively (Everall & Paulson, 2004) and as such should
apply to all human service providers and not just those who are challenged
with burnout and/or compassion fatigue.

Collegial Corrective Response

In addition to self-monitoring and supervision, the human service pro-
vider has a professional and ethical responsibility to address concerns that

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366–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Table 14.2 Mandate for Professional Support and Assistance

Professional
Organization Statement on Ethical Principles Regarding Objectivity

American
Counseling
Association (2014)

Principle C.2.g.

Counselors monitor themselves for signs of impairment from their
own physical, mental, or emotional problems and refrain from
offering or providing professional services when impaired. They
seek assistance for problems that reach the level of professional
impairment, and if necessary, they limit, suspend, or terminate their
professional responsibilities until it is determined that they may
safely resume their work.

American
Psychological
Association (2010)

Principle 2.06.b.

When psychologists become aware of personal problems that may
interfere with their performing work-related duties adequately,
they take appropriate measures, such as obtaining professional
consultation or assistance, and determine whether they should
limit, suspend, or terminate their work-related duties.

American
Association for
Marriage and Family
Therapy (2015)

Principle 3.3

Marriage and family therapists seek appropriate professional assistance
for issues that may impair work performance or clinical judgment.

International
Association
for Group
Psychotherapy and
Group Processes
(2009)

Principle 2.7

Group psychotherapists shall ensure that their own physical
and mental health allows them to undertake their professional
responsibilities competently. They shall seek appropriate assistance or
professional treatment should they suffer ill health or compromised
mental health that interferes with their professional duties.

National Association
of Social Workers
(2009)

Principle 4.05.b.

Social workers whose personal problems, psychosocial distress,
legal problems, substance abuse, or mental health difficulties
interfere with their professional judgment and performance should
immediately seek consultation and take appropriate remedial
action by seeking professional help, making adjustments in
workload, terminating practice, or taking any other steps necessary
to protect clients and others.

arise when observing colleagues who are demonstrating signs of impairment
(Everall & Paulson, 2004). Clearly a colleague who exhibits signs of fatigue,
loss of interest in his work, and an abrasive, dismissive attitude toward his

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Chapter 14. Competence and the Ethics of Self-Care –●–367

clients is giving evidence of impairment and may be providing less than ethi-
cal and effective service.

As ethical human service providers, we are directed to protect all cli-
ents as well as the image and reputation of our professions. It is our ethical
responsibility to confront impaired colleagues by offering support and pro-
viding collegial corrective feedback. Counselors, for example, are directed
to “assist colleagues or supervisors in recognizing their own professional
impairment and provide consultation and assistance when warranted with
colleagues or supervisors showing signs of impairment and intervene as
appropriate to prevent imminent harm to clients.” (ACA, 2014, Principle
C.2.g). A similar directive is given to social workers who are advised to not
only “consult with that colleague when feasible and assist the colleague in
taking remedial action” (NASW, 2008, Principle 2.09.a) but even “take action
through appropriate channels established by employers, agencies, NASW,
licensing and regulatory bodies, and other professional organizations”
(NASW, 2008, Principle 2.09.b) when an impaired colleague, once confronted,
fails to take steps to address the impairment.

While it may be uncomfortable to confront a colleague exhibiting clear
signs of impairment, it is our ethical responsibility. We are directed to ini-
tially attempt to provide support and increase awareness by bringing our
concerns to the impaired professionals. However, if such an informal reso-
lution fails to bring an ethical resolution, then it is essential for us to take
further action appropriate to the situation, including reporting to employer,
state boards and licensing agencies, or even national committees when
national certification is at risk.

CONCLUDING CASE ILLUSTRATION ●

While the focus of our ongoing case has been on Ms. Wicks and her interac-
tion with Maria, the following exchange between Ms. Wicks and her supervi-
sor, Mr. Harolds, suggests that Ms. Wicks may be struggling to maintain her
ability to provide effective, ethical service to her students. As you read the
exchange, be aware of any indications that Ms. Wicks may be experiencing
either burnout and/or compassion fatigue and may have either violated an
ethical principle or is close to doing so. Finally, after reading and reflect-
ing upon the interaction consider the points raised in the section entitled
Reflections.

Mr. Harolds: Hi, Michelle, thanks for coming down.

Ms. Wicks: Not a problem . . . a little rushed since I have tons of kids to see.
I was kind of surprised to get your invite. Is something up?

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368–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Mr. Harolds: No, I just wanted to check in and see how things were going
with Maria and the year so far.

Ms. Wicks: Maria, yikes! I’ll tell you Tom, I can’t get her off my mind. This
kid is carrying such a heavy load. It’s just not fair. And truth
be told, there are so many others this year that are in the same
situation.

Mr. Harolds: It sounds like she has really gotten you concerned.

Ms. Wicks: This is so different than other years. Besides Maria, I am seeing at
least four others who are being abused or had been abused. . . .

Mr. Harolds: Michelle, are you saying you have evidence of abuse? Why
haven’t you told me before now? We need to report it.

Ms. Wicks: Well, it’s not abuse in the legal sense. It’s just life has dealt
these kids unfair demands, and it’s just not fair (starts to tear
up). I mean, I feel like I should take them all home and keep
them safe and . . .

Mr. Harolds: Michelle, I can see you are concerned and this upsetting, but I
hope you really don’t mean what you are saying about taking
them home.

Ms. Wicks: I know, and truthfully . . . I go between wanting to hug them
and protect them to wanting to grab them by the collar and
start pounding some sense in their heads. Their view of sex,
babies, being “what their man” wants. . . . I just want to yell
“damn girl, what’s wrong with you!”

Mr. Harolds: Michelle, this doesn’t sound like you. It feels like you are
getting a little worn down?

Ms.Wicks: Tom, this year has been hell. The entire class seems to be
dealing with such heavy stuff. It just seems so unfair (starts
to tear up again and is visibly upset). I’m sorry, Tom. I know
this is totally inappropriate, but it is mind boggling what
these kids are dealing with, and I guess I’m realizing that I
am totally impotent in helping them. I look at what is going
on and I vacillate from wanting to wrap my arms around
them—take them home with me, and keep them all safe—
to literally giving up and telling them all to deal with it on
their own. I know it’s not professional, but sometimes I get
so angry that . . . that . . . I don’t know, maybe the semester

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Chapter 14. Competence and the Ethics of Self-Care –●–369

break coming up is all I need. Just a little time away from this
place and the job.

Mr. Harolds: Michelle, I know we have talked about this before . . . but you
do give your all . . . I mean you are here early before school
and usually the last to leave. Also, I don’t think you ever miss a
student activity if you can help, plus all the support you give to
parents and faculty. . . . You know maybe you need to cut back
a bit.

Ms. Wicks: Cut back . . . really? Tom, there is so much these kids need
(again, starts to tear up). I mean, I spent all day Saturday visiting
some of them, bringing some clothes, makeup, and a little treat
to the girls in Lincoln apartments.

Mr. Harolds: Michelle that truly concerns me. While I am sure that the girls
had fun and appreciated you bringing things, that’s not your
role, and while it is a nice gesture, it really isn’t necessary or
even appropriate. I am worried that you are taking more on
and emotionally extending yourself in ways that are not healthy
for you and, honestly, can put you at risk.

Reflections

1. What type of “risk” do you feel Mr. Harolds was referring to? Physical?
Emotional? Professional? Legal?

2. Is there any evidence that might suggest that Michelle is beginning to
experience burnout? Compassion fatigue? Or is she setting herself up
for such an experience?

3. What ethical principles has Michelle violated? Are there any that she
is coming close to violating?

COOPERATIVE LEARNING EXERCISE ●

Introduction: Below you will find the Compassion Satisfaction and Compas-
sion Fatigue (PROQOL), Version 5 scale. We invite you to not only make a
copy of this scale and refer to it frequently throughout your career but also
take time now to take a snapshot of your current state of well-being. We
suggest you work through the scale with your colleague and/or supervisor,
discussing your responses.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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370–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Exercise 14.3

Monitoring Burnout and Compassion Fatigue

Directions:
COMPASSION SATISFACTION AND COMPASSION FATIGUE

(PROQOL) VERSION 5 (2009)
When you [help] people, you have direct contact with their lives.

As you may have found, your compassion for those you [help] can
affect you in positive and negative ways. Below are some questions
about your experiences, both positive and negative, as a [helper].
Consider each of the following questions about you and your current
work situation. Select the number that honestly reflects how frequently
you experienced these things in the last 30 days.

1 =
Never

2 =
Rarely

3 =
Sometimes

4 =
Often

5 =
Very Often

1. I am happy.

2. I am preoccupied with more than one person I [help].

3. I get satisfaction from being able to [help] people.

4. I feel connected to others.

5. I jump or am startled by unexpected sounds.

6. I feel invigorated after working with those I [help].

7. I find it difficult to separate my personal life from my life as a
[helper].

8. I am not as productive at work because I am losing sleep over
traumatic experiences of a person I [help].

9. I think that I might have been affected by the traumatic stress
of those I [help].

10. I feel trapped by my job as a [helper].

11. Because of my [helping], I have felt “on edge” about various
things.

12. I like my work as a [helper].

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 14. Competence and the Ethics of Self-Care –●–371

13. I feel depressed because of the traumatic experiences of the
people I [help].

14. I feel as though I am experiencing the trauma of someone I
have [helped].

15. I have beliefs that sustain me.

16. I am pleased with how I am able to keep up with [helping]
techniques and protocols.

17. I am the person I always wanted to be.

18. My work makes me feel satisfied.

19. I feel worn out because of my work as a [helper].

20. I have happy thoughts and feelings about those I [help] and
how I could help them.

21. I feel overwhelmed because my case [work] load seems
endless.

22. I believe I can make a difference through my work.

23. I avoid certain activities or situations because they remind
me of frightening experiences of the people I [help].

24. I am proud of what I can do to [help].

25. As a result of my [helping], I have intrusive, frightening
thoughts.

26. I feel “bogged down” by the system.

27. I have thoughts that I am a “success” as a [helper].

28. I can’t recall important parts of my work with trauma
victims.

29. I am a very caring person.

30. I am happy that I chose to do this work.

Based on your responses, place your personal scores below. If you
have any concerns, you should discuss them with a physical or mental
health care professional.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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372–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Compassion Satisfaction

Compassion satisfaction is about the pleasure you derive from being
able to do your work well. For example, you may feel like it is a pleasure
to help others through your work. You may feel positively about your
colleagues or your ability to contribute to the work setting or even the
greater good of society. Higher scores on this scale represent a greater
satisfaction related to your ability to be an effective caregiver in your job.

The average score is 50 (SD 10; alpha scale reliability .88). About
25 percent of people score higher than 57 and about 25 percent of
people score below 43. If you are in the higher range, you probably
derive a good deal of professional satisfaction from your position. If
your scores are below 40, you may either find problems with your job,
or there may be some other reason—for example, you might derive
your satisfaction from activities other than your job.

Burnout

Most people have an intuitive idea of what burnout is. From the
research perspective, burnout is one of the elements of compassion
fatigue. It is associated with feelings of hopelessness and difficulties
in dealing with work or in doing your job effectively. These negative
feelings usually have a gradual onset. They can reflect the feeling that
your efforts make no difference, or they can be associated with a very
high workload or a non-supportive work environment. Higher scores
on this scale mean that you are at higher risk for burnout.

The average score on the burnout scale is 50 (SD 10; alpha scale
reliability .75). About 25 percent of people score above 57 and about
25 percent of people score below 43. If your score is below 43, this
probably reflects positive feelings about your ability to be effective in
your work. If you score above 57 you may wish to think about what
at work makes you feel like you are not effective in your position. Your
score may reflect your mood; perhaps you were having a “bad day” or
are in need of some time off. If the high score persists or if it is reflective
of other worries, it may be a cause for concern.

Secondary Traumatic Stress

The second component of compassion fatigue is secondary traumatic
stress (STS). It is about your work-related, secondary exposure to

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 14. Competence and the Ethics of Self-Care –●–373

extremely or traumatically stressful events. Developing problems
because of exposure to other’s trauma is somewhat rare but does
happen to many people who care for those who have experienced
extremely or traumatically stressful events. For example, you may
repeatedly hear stories about the traumatic things that happen to other
people, commonly called vicarious traumatization. If your work puts you
directly in the path of danger, for example, fieldwork in a war or area of
civil violence, this is not secondary exposure; your exposure is primary.
However, if you are exposed to others’ traumatic events as a result of
your work—for example, as a therapist or an emergency worker—this
is secondary exposure. The symptoms of STS are usually rapid in onset
and associated with a particular event. They may include being afraid,
having difficulty sleeping, having images of the upsetting event pop into
your mind, or avoiding things that remind you of the event.

The average score on this scale is 50 (SD 10; alpha scale
reliability .81). About 25 percent of people score below 43 and about
25 percent of people score above 57. If your score is above 57, you
may want to take some time to think about what at work may be fright-
ening to you or if there is some other reason for the elevated score.
While higher scores do not mean that you do have a problem, they are
an indication that you may want to examine how you feel about your
work and your work environment. You may wish to discuss this with
your supervisor, a colleague, or a health care professional.

Source: B. Hundall Stamm, 2009–2012. Professional Quality of Life:
Compassion Satisfaction and Fatigue Version 5 (ProQOL).

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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374–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

In this section, you will score your test so you understand the interpretation for you. To find your
score on each section, total the questions listed on the left and then find your score in the table on
the right of the section.

WHAT IS MY SCORE AND WHAT DOES IT MEAN?

Compassion Satisfaction Scale

Copy your rating on each of these
questions on to this table and add
them up. When you have added
them up you can find your score on
the table to the right.

3. ____
6. ____

12. ____
16. ____
18. ____
20. ____
22. ____
24. ____
27. ____
30. ____
Total: _____

The Sum
of My

Compassion
Satisfaction
Questions Is

So My
Score
Equals

And My
Compassion
Satisfaction

Level Is

22 or less 43 or less Low

Between
23 and 41

Around 50 Average

42 or more 57 or more High

Burnout Scale

On the burnout scale you will need
to take an extra step. Starred items
are “reverse scored.” If you scored
the item 1, write a 5 beside it. The
reason we ask you to reverse the
scores is because scientifically the
measure works better when these
questions are asked in a positive
way though they can tell us more
about their negative form. For

example,
question 1. “I
am happy” tells
us more about
the effects of
helping when
you are not
happy so you
reverse the
score.

*1. ____ = ____
*4. ____ = ____
8. ____

10. ____
*15. ____ = ____
*17. ____ = ____
19. ____
21. ____
26. ____

*29. ____ = ____
Total: _____

The Sum of
My Burnout
Questions Is

So My
Score
Equals

And My
Burnout
Level Is

22 or less 43 or less Low

Between 23
and 41

Around 50 Average

42 or more 57 or more High

You
Wrote

Change
to

5

2 4

3 3

4 2

5 1

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 14. Competence and the Ethics of Self-Care –●–375

Source: B. Hudnall Stamm 2009–2012. Professional quality of life: Compassion satisfaction and fatigue version 5
(ProQOL). www.proqol.org. This test freely copied as long as (a) author is credited, (b) no changes are made, and
(c) it is not sold. Those interested in using the test should visit www.proqol.org to verify that the copy they are using
is the most current version of the test.

Secondary Traumatic Stress Scale

Just like you did on Compassion
Satisfaction, copy your rating on
each of these questions on to this
table and add them up. When you
have added them up you can find
your score on the table to the right.

2. ____
5. ____
7. ____
9. ____

11. ____
13. ____
14. ____
23. ____
25. ____
28. ____
Total: _____

The Sum
of My

Secondary
Trauma

Questions Is

So My Score
Equals

And My
Secondary
Traumatic

Stress Level
Is

22 or less 43 or less Low

Between 23
and 41

Around 50 Average

42 or more 57 or more High

• The stress of taking on the responsibility for assisting one in crisis,
especially when work conditions are such as to add to that stress or,
conversely, fail to provide the essential support necessary for pro-
viding ethical, effective service, can accumulate and will negatively
impact the provider’s ability to perform competently.

• Burnout is experienced as emotional exhaustion and often manifests
in form of apathy, negative job attitude, and perhaps most concern-
ing from an ethical perspective of competence, a loss of concern and
feeling for the client.

• Compassion fatigue has been defined as a “state of exhaustion and
dysfunction—biologically, psychologically and socially—as a result
of prolonged exposure to compassion stress (Figley, 1995, p. 253).

• Compassion fatigue differs from burnout out in that it occurs suddenly
rather than gradually, as is the case with burnout, and presents often
with symptoms that mirror post-traumatic disorders (Trippany, Wil-
coxon, & Satcher, 2003). As such it is often referred to as secondary
post-traumatic stress disorder.

• Both burnout and compassion fatigue can impair one’s ability to pro-
vide ethical care and service.

• The disengagement and devaluing of the client that often accom-
panies burnout and compassion fatigue diminishes a practitioner’s

SUMMARY ●

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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376–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

interest and ability to effectively engage with a client to devise, imple-
ment, and maintain an effective treatment plan.

• Self-care is essential to ethical, competent practice. The ethics of self-care
have been made clear by a number of our professional organizations.

• Our professional codes of ethics are clear in directing us to cease and
desist our engagement with a client once we become aware that we
are compromised as professionals.

• Beyond refraining from practice, impaired human service providers
should seek appropriate professional assistance for issues that may
impair work performance or clinical judgment.

• It is our ethical responsibility to confront impaired colleagues by
offering support and providing collegial corrective feedback.

● IMPORTANT TERMS

beneficence

burnout

collegial correction

compassion fatigue

dehumanization

enduring stress

nonmaleficence

self-awareness

self-care

self-monitoring

wellness

● ADDITIONAL RESOURCES

Print

Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and pro-
fessional well-being. Washington, DC: American Psychological Association.

Kottler, J. A. (2012). The therapist’s workbook: Self-assessment, self-care and
self-improvement exercises for mental health professionals (2nd ed.). Hoboken,
NJ: John Wiley & Sons.

Ladany, N. (2010). Counselor supervision. New York: Routledge
Skovholt, T. M., & Trotter-Mathison, M. (2011). The resilient practitioner: Burnout

prevention and self-care strategies for therapists, counselors, teachers and
health professionals (2nd ed.). New York: Routledge.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 14. Competence and the Ethics of Self-Care –●–377

Web-Based

ACA’s Taskforce on Counselor Wellness and Impairment. Retrieved from www
.counseling.org/ wellness_taskforce/index.htm

ProQOL.org. (n.d.). ProQOL 5. Retrieved from http://proqol.org/ProQol_Test.html
PTSD Support Services. (n.d.). Compassion fatigue self-test. Retrieved from http://

www.ptsdsupport.net/compassion_fatigue-selftest.html

REFERENCES ●

American Association for Marriage and Family Therapy. (2015). Code of ethics.
Retrieved from https://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/
code_of_ethics.aspx

American Counseling Association. (2014). Code of ethics, Washington, DC: Author.
American Counseling Association’s Task force on Counseling Wellness and Impairment.

(2010). Retrieved from http://www.counseling.org/wellness_taskforce/index
.htm

American Mental Health Counselors Association. (2010). American Mental Health
Counselors Association (AMHCA) Code of ethics. Retrieved from http://www
.amhca.org/assets/content/AMHCA_Code_of_Ethics_11_30_09b1.pdf

American Psychological Association. (2010). Ethical principles of psychologists and
code of conduct. Retrieved from http://www.apa.org/ethics/code/principles
.pdf

Baird, B. N. (2008). The internship, practicum, and field placement handbook:
A guide for the helping professions (5th ed). Upper Saddle River, NJ: Pearson/
Prentice Hall.

Bakker, A. B., Van der Zee, K. I., Lewig, K. A., & Dollard, M. F. (2006). The relation-
ship between the big five personality factors and burnout: A study among volun-
teer counselors. The Journal of Social Psychology, 126, 31–50.

Everall, R. D., & Paulson, B. L. (2004). Burnout and secondary traumatic stress:
Impact on ethical behaviour. Canadian Journal of Counselling, 38(1), 25–33.

Figley, C. R. (Ed.). (1995). Compassion fatigue: Coping with secondary traumatic
stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Frankl, V. (1963). Man’s search for meaning. New York: Simon and Shuster.
Gladding, S. T. (2011). The counseling dictionary: Concise definitions of frequently

used terms. Upper Saddle River, NJ: Pearson Education.
International Association for Group Psychotherapy and Group Processes. (2009).

Retrieved from http://www.iagp.com/about/ethicalguidelines.htm
Lambie, G. W. (2002). The contribution of ego development level to degree of

burnout in school counselors (Doctoral dissertation, The College of William &
Mary, 2002). Dissertation Abstracts International, 63, 508.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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378–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Lee, S. M., Baker, C. R., Cho, S. H., Heckathorn, D. E., Holland, M. W., Newgent, R. A., &
Yu, K. (2007). Development and initial psychometrics of the Counselor Burnout
Inventory. Measurement and Evaluation in Counseling and Development, 40,
142–154.

Maslach, C. (1993). Burnout: A multidimensional perspective. In W. B. Schaufeli,
C. Maslach, & T. Marek (Eds.), Professional burnout: Recent developments in
theory and research (pp. 19–32). Philadelphia, PA: Taylor & Francis.

Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of
Psychology, 52, 397–422.

National Association of Social Workers. (2008). Code of ethics of the National
Association of Social Workers (NASW). Retrieved from http://www.socialworkers
.org/pubs/code/code.asp

Norcross, J. C. (2000). Psychotherapist self-care: Practitioner-tested, research-
informed strategies. Professional Psychology: Research and Practice, 31,
710–713.

O’Brien, J. M. (2011). Wounded healer: Psychotherapist’s grief over a client’s death.
Professional Psychology Research and Practice, 42, 236–243.

Parsons, R. D., & Zhang, N. (2014). Becoming a skilled counselor. Thousand Oaks,
CA: Sage.

Rupert, P. A., & Kent, J. S. (2007). Gender and work setting differences in
career- sustaining behaviors and burnout among professional psychologists.
Professional Psychology: Research and Practice, 38, 88–96.

Skovholt, T. M. (2001). The resilient practitioner: Burnout prevention and self-
care strategies for counselors, therapists, teachers, and health professionals.
Boston: Allyn & Bacon.

Stamm, B. H. (2012). The Professional Quality of Life Scale (ProQOL 5). Retrieved
from http://proqol.org/ProQol_Test.html

Trippany, R. L., White Kress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious
trauma: What counselors should know when working with trauma survivors.
Journal of Counseling & Development, 82, 31–37.

Trippany, R. L., Wilcoxon, S. A., & Satcher, J. F. (2003). Factors influencing vicarious
trauma for therapists of survivors of sexual victimization. Journal of Trauma
Practice, 2, 47–60.

Ulman, K. H. (2008). Helping the helpless. Group, 32(3), 209–221.
Wildans, A. (n.d.). BrainyQuote.com. Retrieved June 23, 2016, from BrainyQuote.com

Web site: http://www.brainyquote.com/quotes/authors/a/anton_wildgans.htm
Zhang, N., & Parsons, R. D. (2016). Field experience: Transitioning from student to

professional. Thousand Oaks, CA: Sage.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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