The purpose of this dissertation study was to increase understanding of licensed mental health professionals' experiences as they have encountered and navigated through compassion fatigue (CF). CF is a complex construct with an attendant constellation of secondary stress responses. In order to examine the complex and varying factors associated with experiencing CF, the research was conducted using a grounded theory, qualitative approach and methodology. Nine licensed mental health professionals across the disciplines of marriage and family therapy, mental health counseling, professional counseling, psychology, and social work were individually interviewed three times, for a total of at least 180 minutes. All interviews were recorded, transcribed and analyzed. As a result of the analyses, four main categories emerged, experiencing internal dissonance, recognizing and processing the effects, becoming intentional, and creating ongoing changes. Becoming intentional is the central category because of its central and pivotal relationship to the whole process of participants' experience of encountering and navigating through CF. This fulcrum punctuates participants' experiences leading up to becoming intentional and those which came after as delineated in the other three categories of the theory. Prior to becoming intentional, participants experienced internal dissonance, which escalated to distress or crisis. When this distress or crisis reached a point where it became untenable, participants recognized and processed the effects. One of the effects which participants came to recognize was a loss of internal locus of control. Becoming intentional served as a catalyst for participants to take action and recapture their locus of control. The process of becoming intentional is reflected in three practices, transforming perceptions, developing support, and making professional changes. These findings are applicable to a variety of models of counseling, supervision, counselor education, and clinical practice in either a single or interdisciplinary setting. / Graduation date: 2013

This study was inspired by the desire to understand the experience of mental health clinicians coping with work related stress in treating traumatized children. In studying this experience, heuristic design and methodology was followed. The findings of this study are based on interviews of 3 Caucasian, female clinicians, a 49-year-old art therapist with eight years experience, a 61-year-old licensed clinical social worker with 34 years of postgraduate experience, and a 44-year-old licensed clinical social worker with 21 years of experience. Mental health practitioners, clinical supervisors and consultants as well as professionals in counselor education benefit from the findings of this study that extends knowledge of effective coping with work related stress in treating traumatized children. Participants in this study coped by using the following core characteristics the most often: seeking emotional and instrumental support from others, maintaining balance in work and private life, staying spiritually oriented, participating in leisure activities, focusing on health and using cognitive restructuring techniques. The least mentioned was the use of humor. Four themes permeated the experience of these clinicians: (1) Maintaining Balance: Coping included maintaining a balance in work and private life; (2) Healthy Personal Identity: Coping successfully meant keeping the career as work and not a definition of the self; (3) Clear Role Definition: Coping to continue the work included increased focus on professional and personal boundaries and the role of the clinician; (4) Realistic Control: Successful coping included differentiating between what can and can't be controlled. This study also found that part of coping with work-related stress meant moving from the public sector into private enterprise. In private practice, participants found that coping with stress improved with the decrease of high client caseload requirements and the ability to screen potential clientele for the purpose of creating a balance in treatment issues. Overall, this study found that the experience of coping successfully with work-related stress had a great deal to do with increased professional autonomy. / Graduation date: 2003

Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

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The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses. / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008