1. Therapeutic Alliance,
Compassion Fatigue, and It’s
Impact On Crisis Work
By Sean Erreger, LCSW
Peer Support Call by the National Association of Crisis Organization Directors
September 15, 2015

2. Objectives
• Define Transference and Counter-Transference; Identifying its impact on
crisis work
• Defining the Therapeutic relationship and it’s impact on crisis work
• Some helpful tools to help your organization problem solve problems within
the therapeutic relationship, compassion fatigue and it’s impact on your
workforce.

3. Transference
• …the clients resistance, the transference-feelings wishes, fears, and defenses
that influence the clients perceptions of the therapist” (Strean, 1996).
• “the clients’ experience of the therapist that is shaped by his or her own
psychological structures and past, and involves displacement onto the
therapist, of feelings, attitudes and behaviors belonging rightfully to in earlier
significant relationship.” (Gelso and Hayes, 1998)

4. Transference
• Can be positive
• Your voice Sounds like my best friend
• Can be negative
Your voice may be similar to the person that sexually assaulted
• How has transference effected your Crisis Work?

5. Counter-Transference

6. Counter-Transference
• “We have begun to consider the ‘counter transference’ which arises in the
physician as a result of the patient’s influence on his unconscious feelings,
and have nearly come to the point of requiring the physician to recognize
and overcome this counter transference in himself… We have noticed that
every analyst’s achievement is limited by what his own complexes and
resistances permit.” (Freud ,1910/1959)

7. Counter-Transference (cont.)
• “Counter transference is the same dynamic phenomenon as transference
except it refers to those unconscious wishes and defenses, which are always
part of the perception and treatment of the client” (Strean, 1996).
• Hayes (2004) argues that the notion of the unconscious slowly evolved to
include any emotional reaction by the therapist to a client’s words or actions

8. Emotional Reactions
• My Example:
• How Does Emotional reactions effect you and your staff?

9. Therapeutic Alliance

10. Therapeutic Alliance
• Robert Hatcher (2010) defines Therapeutic Alliance as “a way of talking
about the quality of collaborative work between the patient and therapist.
Asking the critical question of a patient feeling like that they are working
together toward goals of therapy in a single session, a month, or throughout
therapy thus far”.
• Transference, Counter-transference, and therapeutic alliance taken together
can have a significant impact on your crisis workforce.

11. Measuring Therapeutic Alliance
Examined 3 scales…
• 1) Shared Goals
• 2) Subjective feelings
• 3) The process of therapy
• 4) being mindful of the potential for a rupture/impasse in the relationship.
• Mainly focused on long term work…

12. Scales Relevant to Crisis Work
• Professional Quality of Life Scale (ProQOL,)
• The Shared Traumatic and Professional Postraumatic Growth Inventory
(STPPG) (Tosone, Bauwens, and Glassman, 2014 )
Here is why I think they are helpful/useful tools for crisis directors..

13. Professional Quality of Life Scale (ProQOL)
• The ProQOL is free
• A 30 item self report measure of the positive and negative aspects of caring
• The ProQOL measures Compassion Satisfaction and Compassion Fatigue
• Compassion Fatigue has two subscales
• Burnout
• Secondary Trauma
Available at http://www.proqol.org/ProQol_Test.html

14. Professional
Quality
of Life
Compassion
Fatigue
Compassion
Satisfaction
(ProQOL CS)
Work
Environment
Client
Environment
Personal
Environment
Traumatized
by work
Secondary
Exposure
(ProQOL STS)
Primary
Exposure
Frustration
Anger
Exhaustion Depressed by
Work
Environment
(ProQOL
Burnout)

15. Some Sample Questions from ProQol
• 7. I find it difficult to separate my personal life from my life as a [helper].
• I am not as productive at work because I am losing sleep over traumatic
experiences of a person I [help]
• 20. I have happy thoughts and feelings about those I [help] and how I could
help them
• 25. As a result of my [helping], I have intrusive, frightening thoughts.
• 27. I have thoughts that I am a "success" as a [helper].

16. The Shared Trauma/Professional Growth
Inventory (STPPG- Tosone, Bauwens and
Glassman, 2014)
• 14 Item Likert scale inventory about how “true” their response was.
• Focus on Post-Traumatic Growth- How did the shared experience of trauma
have an impact on your professional work?
• Assumption that crisis call is both potentially traumatic for the person calling
and for the worker receiving the call.
• Specific measure was for shared experiences around Hurricane Katrina but
questions can be a great tool for supervision for crisis directors..

17. Sample Questions for STPPG
• As a result of my personal experience with Hurricane Katrina, the
boundaries with my clients changed after the event
• As a result of my personal experience with Hurricane Katrina, I’ve changed
my practice orientation (e.g., theoretical or technical approach)
• As a result of my personal experience with Hurricane Katrina, I’m triggered
by my clients’ traumatic reactions to the event

18. STPPG and Post-Traumatic Growth
• Brings up the notion of Post Traumatic Growth
• First measured for professionals by (Tedeschi and Calhoun, 1996)
• Changes in Self, Changes in Relationships with others, and changes in
philosophy of life.

19. Post-Traumatic Growth Inventory
Tedeschi and Calhoun, 1996

20. Conclusions
• The concepts of Counter-transference and compassion fatigue have a
significant impact on crisis work. Crisis Directors can address this using
several tools.
• The impact does not always have to negative, we can focus on the notion of
post traumatic growth and learning from shared experience.

21. Follow Up
• Would love to hear feedback if these tools helped or if your group is
interested in more information…
Email: stuckonsw@yahoo.com
Blog : www.stuckonsocialwork.wordpress.com
Twitter: @StuckOnSW

22. References
Freud, S. (1910) Future Prospects of Psychoanalytic Psychotherapy. In J. Stratchey (Ed. And Trans). The standard of the
complete psychological works of Sigmund Freud Volume 11 pp. 139-151. London Hogarth press. Originally published in
1910.
Gelso, C.J, and Hayes, J.A. (1998) The psychotherapy relationship, New York, NY: Wiley
ProQol.org. Professional Quality of Life Scale (English) retrieved 8/15/15 at http://www.proqol.org/ProQol_Test.html
Customize a Presentation on Compassion Satisfaction, Compassion Fatigue & Secondary Traumatic Stress [Powerpoint Slides]
retrieved 8/15/15 at http://www.proqol.org/Customize_a_Presentation.html
Stearn, H.S. (1996) Psychoanalytic Therapy and social work treatment. In F.J Turner. Social Work Treatment : Interlocking
approaches.(4th Edition, pages 523-554) Free Press: New York
Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma.
Journal of traumatic stress, 9(3), 455-471.
Tosone, C., Bauwens, J., & Glassman, M. (2014). The Shared Traumatic and Professional Posttraumatic Growth Inventory.
Research on Social Work Practice, 1049731514549814.