by Diane Bridgeman, Ph.D.

Updated, 2008

There is wisdom in embracing a strength-based approach to mental health work in general, and in disaster mental health work specifically. Such a framework can offer a more positive, hopeful, thoughtful context in which to provide support and insight. One
such approach is to employ concepts such as those associated with variants of resilience. Typically resilience is defined as the ability to adapt to, and cope with, or in some cases, I propose, to lessen or even prevent the negative impact of challenging experiences.

Whether as a psychotherapist or disaster mental health professional, we can better hold, support and process our own feelings and those of our clients when acknowledgement of their challenge is coupled with exploration of relational connectedness, trust, empathy, and their areas of strength.

As is inherent in any paradigm, it is important to be mindful to not unwittingly minimize difficult experiences, or reinforce negative challenges when integrating a more optimistic approach. These tendencies can be avoided with thoughtfulness and the use of our clinical lens with respect to relevant factors such as:

• Awareness of the person’s prior difficult experiences and the similarities to this
  specific incident.
• Knowledge of their strengths, insights & abilities in coping with previousdifficulties.
• Length of time from your interaction with them and the incident.
• Strength & intactness of their current support system & resources.
• Their mental and physical health status prior to incident & currently.
• Their age and gender.
• Their closeness to the traumatic experience in actual time & space.

With the above variables in mind the mental health professional can then support the person to:

• Borrow from their previous experience when they were able to cope with challenging experiences and view those past accomplishments as evidence of their ability to deal with life’s serious confrontations.
• Maintain close relational connections, or re-connect with those who are supportive & trusting.
• Frame the challenge into a larger perspective of experiences.
• Value the lessons learned as part of personal development & growth.
• Practice healthy self-care now and on an ongoing basis.
• Set times for joyful & centering activities, help others, & give back.

These and other examples of positive strategies described below can be helpful when approached and tailored appropriately for each individual and not in a rote fashion. Most importantly, resilience is an asset not only for minimizing serious consequences but if embraced on a sustained basis it can be a preventive strategy to facilitate better coping when challenges arise, or perhaps in some cases, even mitigate negative impacts as a
result. Striving for wellness and employing preventive strategies are important for those we serve but also for us as mental health professionals, and especially if dealing with serious traumas on an ongoing basis.

To assist us in truly doing diligence please take the following “Professional Quality of Life Scale” to maintain your wellness so that you can better serve your clients and enhance your own quality of life.

ProQOL R-IV

PROFESSIONAL QUALITY OF LIFE SCALE

Compassion Satisfaction and Fatigue Subscales—Revision IV

[Helping] people puts you indirect contact with their lives. As you probably have
experienced, your compassion for those you [help]has both positive and negative aspects.
We would like to ask you questions about your experiences, both positive and negative,
as a [helper]. Consider each of the following questions about you and your current
situation. Select the number that honestly reflects how frequently you experienced these
characteristics in the last 30days.

0=Never 1=Rarely 2=A Few Times 3=Somewhat Often 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 losing sleep over traumatic experiences of a person I [help].
____ 9. I think that I might have been “infected” by the traumatic stress of those I
[help].
____ 10. I feel trapped by my work as a [helper].
____ 11. Because of my [helping], I have felt “on edge” about various things.
____ 12. I like my work as a [helper].
____ 13. I feel depressed as a result of my work as a [helper].
____ 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. Because of my work as a [helper], I feel exhausted.
____ 20. I have happy thoughts and feelings about those I [help] and how I could
help them.
____ 21. I feel overwhelmed by the amount of work or the size of my case[work]load
I have to deal with.
____ 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 sensitive person.
____ 30. I am happy that I chose to do this work.

Copyright Information

© B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction
and Fatigue Subscales, R-IV (ProQOL). http://www.isu.edu/~bhstamm. This test may be
freely copied as long as (a) author is credited, (b) no changes are made other than those
authorized below, and (c) it is not sold. You may substitute the appropriate target group
for [helper] if that is not the best term. For example, if you are working with teachers,
replace [helper] with teacher. Word changes may be made to any word in italicized
square brackets to make the measure read more smoothly for a particular target group.

Disclaimer

This information is presented for educational purposes only. It is not a substitute for
informed medical advice or training. Do not use this information to diagnose or treat a
health problem without consulting a qualified health or mental health care provider. If
you have concerns, contact your health care provider, mental health professional, or your
community health center.

Self-scoring directions, if used as self-test

1. Be certain you respond to all items.
2. On some items the scores need to be reversed. Next to your response write the
reverse of that score (i.e. 0=0, 1=5, 2=4, 3=3). Reverse the scores on these 5
items: 1, 4, 15, 17 and 29. Please note that the value 0 is not reversed, as its value
is always null.
3. Mark the items for scoring:
a. Put an X by the 10 items that form the Compassion Satisfaction Scale: 3,
6, 12, 16, 18, 20,22, 24, 27, 30.
b. Put a check by the 10 items on the Burnout Scale: 1, 4, 8, 10, 15, 17, 19,
21, 26, 29.
c. Circle the 10 items on the Trauma/Compassion Fatigue Scale: 2, 5, 7, 9,
11, 13, 14, 23,25, 28.
4. Add the numbers you wrote next to the items for each set of items and compare
with the theoretical scores.

The following two sets of guidelines are also meant to embrace and sustain wellness and
resilience. From my perspective, the quality of ones relational connectedness with a few
trusted people in a mutually respected, reciprocal and empathic interaction is the heart of
what contributes to the effectiveness of resilience.

Appreciating the importance of this primary connectedness in your efforts with your
clients and in your own personal life will support the cultivation and sustainment of true
resilience.

Bridgeman’s Relational Concepts for Cultivating Resilience

R = RECIPROCITY – The importance of give & take, sharing, and the considering
of other perspectives.

E = EMPATHY – Identify with the feelings of others, which leads to tolerance &
compassion.

S = SELF-EFFICACY – The ability to work toward & appreciate a sense of
mastery & accomplishment.

I = INSIGHT – Explore patterns, meaningful connections, think critically, question,
be resourceful, & put matters into a larger perspective.

L = LETTING GO – Discard less healthy habits, such as staying stuck or
victimized, & develop realistic strategies. Set goals & incentives for staying
focused on a proactive approach.

I = IMAGINATION – Consider creative ways to move forward & put balance in
your life. Experiment with new hobbies, educational goals and novel interests
such as music, dance, meditation, volunteering, journaling, healthy diet and
regular exercise.

E = EXPECTATION – Expect that sadness & disappointment are part of
everyone’s life from time to time. Learning from challenges to cope better next
time is key.

N = NURTURANCE – Learn to accept, affirm, validate and nurture yourself. The
result is less need for external approval & more to share with others.

C = COMMUNICATION – Express feelings, ask for assistance, delegate, engage
in proactive problem solving, get out negative thoughts in constructive ways,
find confidantes to share experiences & learn to be a good listener. Such
factors contribute to taking responsibility for a healthy life & enhanced self worth.

E = EDUCATION – Academic, social, & civic education elicits more choices,
richness, & life satisfaction.

D. Bridgeman, Ph.D.

Resilience Approach to Self Care Guidelines for Health Care Professionals

• Accept support from others.
• Adjust work schedule for a healthy balance of challenging clients with less demanding ones.
• Develop creative outlets, activities unrelated to work, &/ or volunteer time.
• Take pride in your craft as a professional, as well as in your personal development.
• Acknowledge your limits & strive for flexibility.
• Put balance & nurturing into your ongoing schedule. Consider variants of mindfulness meditation, relaxation strategies, yoga, and healthy self-soothing methods to achieve harmony.
• Value the importance of empathy and going beyond yourself, and appreciate that these concepts can co-exist with good self-care.
• Accept appropriateness of boundary setting as none of us can, nor should, be present for others at all times.

* Review Bridgeman’s relational concepts for cultivating resilience..

Diane Bridgeman, Ph.D.,