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The Role of Empathy in Burnout, Compassion

Satisfaction, and Secondary Traumatic


Stressamong Social Workers
M. Alex Wagaman, Jennifer M. Geiger, Clara Shockley, and Elizabeth A. Segal

Social workers are at risk for experiencing burnout and secondary traumatic stress (STS) as
a result of the nature of their work and the contexts within which they work. Little attention
has been paid to the factors within a social workers control that may prevent burnout and
STS and increase compassion satisfaction. Empathy, which is a combination of physiological
and cognitive processes, may be a tool to help address burnout and STS. This article reports
on the findings of a study of social workers (N=173) that explored the relationship between
the components of empathy, burnout, STS, and compassion satisfaction using the Empathy
Assessment Index and the Professional Quality of Life instruments. It was hypothesized that
higher levels of empathy would be associated with lower levels of burnout and STS, and
higher levels of compassion satisfaction. Findings suggest that components of empathy may
prevent or reduce burnout and STS while increasing compassion satisfaction, and that em-
pathy should be incorporated into training and education throughout the course of a social
workers career.

KEY WORDS: burnout; compassion fatigue; compassion satisfaction; empathy; secondary


traumatic stress

S ocial workers provide support and assistance to


clients in a variety of potentially stressful work
environments. Despite training in self-care,
social workers are especially susceptible to burnout
and secondary traumatic stress (STS) (Lloyd, King, &
Much of the research conducted with social work
ers and burnout has focused on the influence of en-
vironmental factors, such as work environment, on
worker well-being rather than the characteristics or
factors related to the individual (Maslach, Schaufeli,
Chenoweth, 2002). Burnout has been linked to & Leiter, 2001; Schaufeli & Enzmann, 1998). Al-
stressful working conditions, vicarious trauma, and a though sharing emotions may contribute to burn-
lack of resources and support. Without effective strat- out, empathy as a protective factor has not been fully
egies for managing stress and burnout, overall satis explored as a means to address the potential risks
faction with work and helping otherscompassion associated with service-related work. The level of
satisfactionmay be compromised (Stamm, 2010). empathy a social worker has may influence his or
Secondary trauma is the secondhand exposure to her ability to manage the stressors associated with
traumatic events, typically experienced while listening burnout and STS, as well as the level of compassion
to others telling their life stories (Pryce, Shackelford, satisfaction.
& Pryce, 2007). Such vicarious trauma can contribute
to feelings of burnout (van Heugten, 2011). On the WHAT IS BURNOUT?
surface, the relationship between secondary trauma Burnout refers to overwhelming emotional exhaus-
and burnout suggests that sharing the feelings of ones tion, depersonalization, and feelings of professional
clients can be detrimental to a workers mental health. insufficiency. It results from demanding and emo-
However, practitioners are urged to be empathic. tionally charged relationships with clients such that
Competency skills for social work education include an individual can no longer fulfill even the most basic
learning to use empathy to engage diverse client sys- personal and professional responsibilities or duties
tems (Council on Social Work Education, 2014). This (Boyas, Wind, & Kang, 2012; Maslach & Schaufeli,
relationship highlights the need to better understand 1993). Burnout as it applies to social workers is gen-
the role of empathy in social work practice. erally conceptualized as a gradual process that rarely

doi: 10.1093/sw/swv014 2015 National Association of Social Workers 201


occurs suddenly or with one event, but instead builds MacNeil, 2010). The National Institute of Mental
over time as healthy defenses are worn down from Health (2014) reported that the primary symptoms
an onslaught of emotional demands, frustrating of STS include hopelessness, inability to embrace or
job setbacks, or difficult situations or individuals disdain of complexity, avoidance of clients or others,
( Jacobson, Rothschild, Mirza, & Shapiro, 2013). It fear, physical ailments, and minimizing problems and
is believed that the single largest risk factor for de- guilt. One study reported that the prevalence of at
veloping professional burnout is human service work least one symptom of STS among social workers is
in general (Newell & MacNeil, 2010, p. 59). Burn- 70 percent (Bride, 2007).
out has been associated with physical and mental
health problems such as depression, insomnia, and APPROACHES TO REDUCE BURNOUT AND STS
gastrointestinal issues (Burke & Deszca, 1986; Lee & A number of self-care strategies have been suggested
Ashforth, 1996) as well as decreased job performance, for social workers to prevent and manage the risks
increased absenteeism, and high turnover (Kahill, associated with burnout and STS. Figley (2002) and
1988). Burnout has also been shown to lead to lower Stamm (1999) recommended that those working
organizational commitment, which is related to inhuman services and other professionals strive to
higher staff turnover and lower productivity (Maslach address their own personal, familial, emotional, and
& Leiter, 1997), and potentially decreased effective- spiritual needs while responding to the demands
ness in work with clients (McCarthy & Frieze, andneeds placed on them by clients. Setting goals
1999). Practitioners with personal trauma history, and boundaries with regard to breaks at work, work-
anxiety or mood disorder (Newell & MacNeil, load, and client care has also been suggested to re-
2010), personal relationships involving conflict, low duce the risk of burnout (Maslach, 2003). A healthy
threshold for minor annoyances, as well as boredom network of personal connection, compatibility with
or lack of commitment to the profession can be at an an effective supervisor, collegial support, and having
elevated risk for burnout (Kulkarni, Bell, & Hartman, and using a voice at work may also reduce the effects
2013). of burnout and STS (Lakey & Cohen, 2000). Ex
Work behaviors that may signal burnout include perience managing social work challenges with the
chronic tardiness, missing work, poor completion guidance of an effective supervisor or role model
rates or low performance, work errors, or isolation builds resilience and reliance, which help to reduce
from others (Newell & MacNeil, 2010). Work en- burnout risks (Boyas et al., 2012). In general, main-
vironments also invite burnout, such as roles in taining overall physical health with adequate exercise,
which workers have less control of their time or recreation, sleep, and nutrition can also reduce
tasks, higher levels of bureaucracy, lack of clarity susceptibility to STS and burnout (OHalloran &
with job roles, higher work demand, greater confu- OHalloran, 2001; Zimering, Munroe, & Gulliver,
sion of work identities, and difficulties with people 2003).
(Newell & MacNeil, 2010). In addition, disconnect Structured approaches to reducing burnout are
with supervisors or coworkers prompts higher risk typically directed at the individual or the organiza-
of burnout (Kulkarni et al., 2013). tion. The cognitivebehavioral approach, directed
at the individuals, typically involves actions such as
STS AND SOCIAL WORK PRACTICE enhancing job competency through training and
STS is a condition characterized by fatigue that can education, skill development, fostering relaxation
arise from the witnessing or listening to the accounts and social support, and increasing personal coping
of disturbing experiences or traumatic events (Bride, skills (Awa, Plaumann, & Walter, 2010). Organization-
2007). STS can lead to workers experiencing trauma directed approaches include changes in work pro-
themselves, where rumination, flashbacks, physio- cesses, supervision and supervisory relationship eval
logical responses, fear, dread, or other active symp- uation and modification, and increased job control
toms of psychoemotional strain (Bride, 2007) cause and decision making. A combination of personal
interruption in their work (Perkins & Sprang, 2013). and organizational interventions have longer last-
STS is a syndrome comprised of symptoms that ing positive effects in reducing burnout (Awa etal.,
closely resemble those of posttraumatic stress disorder 2010). However, it is believed there is too much
(Bride, 2007) and may include hypervigilance, night- focus on treating burnout after it occurs, rather than
mares, sleeplessness, agitation, or fatigue (Newell & preventing burnout. Newell and MacNeil (2010)

202 Social Work Volume 60, Number 3 July 2015


suggested including consistent and accurate infor- comprehend, share, and respond to the emotions,
mation about the key features, signs, and symptoms gestures, thoughts, and experiences of others (de
of burnout and STS in social work education as a Waal, 2010).
means of raising awareness and preventing burnout Studies agree that empathy is critical for effective
and STS among social workers. clinical practice and positive therapeutic outcomes
(Elliott, Bohart, Watson, & Greenberg, 2011; Gibbons,
COMPASSION SATISFACTION 2011; Neumann et al., 2009). There is also evidence
Compassion satisfaction is the positive feelings that empathy is related to positive moral develop-
about peoples ability to help and relates to quality ment (Eisenberg & Eggum, 2009; Killen & Smetana,
of work life (Stamm, 2010, p. 8). In contrast to 2008) and promotes prosocial behaviors, particularly
burnout or STS, a workers sense of achievement, during adolescence (Batson, Hkansson Eklund,
sustained motivation, or even inspiration and enjoy Chermok, Hoyt, & Ortiz, 2007; Laible, Carlo, &
ment from emotionally demanding social work can Roesch, 2004; McMahon, Wernsman, & Parnes,
prompt compassion satisfaction. Compassion satis- 2006).
faction is an effective means of reducing burnout
and STS as it provides motivation, stamina, interest, THE BUILDING BLOCKS OF EMPATHY
and a sense of accomplishment in aiding clients to Varying definitions of empathy have emerged over
overcome trauma (Bride, Radey, & Figley, 2007). the years; however, recent advances in cognitive neu-
Compassion satisfaction leads to situations in which roscience have identified key components that to-
social workers can vicariously benefit from their gether make up the full array of empathy (Decety,
clients improved functioning, personal growth, or 2011; Decety & Moriguchi, 2007). This research is
therapeutic gains as they share the positive outcomes based on the cognitive neuroscience conceptualiza-
and feelings of empowerment, energy, and exhilara- tion of empathy. As such, empathy comprises four
tion (Pooler, Wolfer, & Freeman, 2014). subjectively experienced components: (1) affective
Providing energy, insight, or strengthened resolve response, (2) selfother awareness, (3) perspective
for helping and service, compassion satisfaction is taking, and (4) emotion regulation (Gerdes, Lietz, &
most commonly seen in heightened performance, Segal, 2011). Affective response is a physiological
positive attitude toward work, enhanced value, or component that involves the automatic and uncon-
greater hope for positive outcomes that resonate scious process of affect sharing, or the mirroring of
among successful social workers (Kulkarni et al., another persons actions. For example, when sitting
2013). Compassion satisfaction may be viewed as with a client who is crying, a practitioner might feel
antithetical to compassion fatigue, where exhaustion as if she or he is going to cry. This is a result of the
or hopelessness takes over ones work, leading to automatic mirroring action that is going on uncon-
burnout (Stamm, 2010). Yet no formula or simplified sciously. Our mirroring neuron system activates the
approach to compassion satisfaction is known. same physiological sensations as if we are actually
doing the action. However, rather than begin to cry,
THE VALUE OF EMPATHY the practitioner experiences the other components
A critical skill in social work practice and other of empathy that are triggered to process this affective
helping professions is the ability to empathize with response. The other three components are cognitive
others, particularly ones clients (Gerdes & Segal, processes. Selfother awareness consists of an ability
2011). Empathy is a multidimensional process in- to recognize and understand ones own emotions and
volving cognitive and affective components of un- thoughts as well as distinguish the self from others.
derstanding and identifying with the thoughts, Perspective taking involves the ability to understand
feelings, and emotional states of others (Batson, anothers experiences while maintaining awareness
2011; Gibbons, 2011). Empathy is the ability to of the self and the distinction from the other. Emo-
understand what other people are feeling and tion regulation refers to ones ability to control or
thinking and is an essential skill in facilitating social regulate ones emotions.
agreement and successfully navigating personal In the aforementioned example, by engaging all
relationships (de Waal, 2010; Toussaint & Webb, three of these cognitive components, the practitio-
2005). Empathy helps to create and maintain social ner is able to feel the clients distress of crying but
relationships and bonds by enabling individuals to recognize the difference between the clients actions

Wagaman et al. / The Role of Empathy in Burnout, Compassion Satisfaction, and Secondary Traumatic Stress 203
and the practitioners own physiological reactions, that includes four subscales measuring the components
use those feelings to engage in deep understanding, of interpersonal empathy (affective response, self
and simultaneously regulate her or his own emotions other awareness, perspective taking, and emotion
so as not to be overwhelmed. For the full array of regulation), with five items each. Items were measured
empathy to occur, all four components need to be on a six-point Likert scale ranging from 1=never
well functioning. Each component, and conse- to 6=always. The Professional Quality of Life Scale
quently empathy as a whole, involves skills that can (ProQOL) consists of three subscales: Compassion
be learned. Satisfaction, Burnout, and STS. Each subscale has
The purpose of this study was to examine the 10 questions. As conceptualized by the scale devel-
relationship between social workers empathy and opers, both burnout and STS are components of a
level of (a) burnout, (b) STS, and (c) compassion latent construct, compassion fatigue. Each item was
satisfaction. The authors hypothesized that the com- measured on a five-point Likert scale ranging from
ponents of empathy would be significant predictors 1=never to 5=very often, and included items such
of lower levels of burnout and STS, and higher lev- as I am preoccupied with more than one person I
els of compassion satisfaction. serve. The ProQOL has been identified as a reliable
and valid measure of compassion satisfaction and the
METHOD components of compassion fatigue (Stamm, 2010).
Data Collection
Field instructors from a large southwestern univer- Sample
sitys school of social work were invited via e-mail to The sample (N=173) was predominantly female
participate in an online, Qualtrics-based survey (87.8 percent, n=151) and white/Caucasian (73.8
(Qualtrics Online Survey Software, 2014). Field in- percent, n=127). Twelve percent (n=21) identified
structors were community-based practitioners who as Latino; 5.8 percent (n=10) identified as African
voluntarily supervised social work students in their American. Participants ranged in age from 20 years
field placements. Field instructors were asked to sup- to over 70 years, with a majority (58 percent,
port a snowball sampling technique by forwarding n=101) being between the ages of 40 and 60. A
the invitation e-mail to other services providers in majority of the sample (97.1 percent, n=168) had
their agencies or communities. Data were collected in a masters degree or higher, and 93.6 percent
July and August of 2011. A total of 185 participants (n=161) of the participants highest degrees were
responded. Of those, 173 reported having at least one in social work. Time working in the profession
degree in social work, and these were included in the ranged from two to over 40 years, with approxi-
analysis for the current study. The study was approved mately 75 percent of the participants (n=131) hav-
by the universitys institutional review board. ing been in the profession for 10 years or longer.
Participants reported working in a broad range of
Measures contexts at the time of the survey, with the most
The online survey included demographic items, common being child welfare (12.1 percent, n=20),
such as gender, race or ethnicity, age, and highest behavioral health (18.8 percent, n=31), health or
level of education. Participants also responded to medical services (18.8 percent, n=31), and school-
items about their professional career and current based services (8.5 percent, n=14). Other work
work: years they had worked as a social services contexts reported by participants included policy/
professional overall; the nature of their current work advocacy, early childhood development, crisis re-
(such as child welfare, behavioral health); whether sponse services, aging, and veteran services. The
their current work was in a direct practice position, largest proportion of participants (42.1 percent,
administrative or supervisory position, or a combi- n=69) reported working in direct practice, with an
nation of both; and years they had worked in their additional 33.5 percent (n=55) reporting doing su-
current position. pervisory or administrative work, and 24.4 percent
Participants also completed measures of empa- (n=40) reporting both. Time having worked in
thy,burnout, compassion satisfaction, and STS. The their current positions ranged from less than a year
Empathy Assessment Index (EAI) is a valid and reli- to 28 years. The majority (58 percent, n=93) re-
able 20-item, self-report instrument (Gerdes, Geiger, ported having been in their current position five
Lietz, Wagaman, & Segal, 2012; Lietz et al., 2011) years or less.

204 Social Work Volume 60, Number 3 July 2015


ANALYTIC STRATEGY RESULTS
Multiple regression was used to analyze three The model results are summarized in Table2. In the
modelsone with the dependent variable burn- first model, with burnout as the dependent vari-
out, a second with the dependent variable compas- able, 24 percent of the variance (R2=.28, adjusted
sion satisfaction, and a third with the dependent R2=.24) was accounted for by the independent vari-
variable STS. Each model included as independent ables listed earlier [F(8, 142)=7.12, p<.01], with
variables the four component scores of empathy emotion regulation [=.36, t(142)=4.08, p<.05]
from the EAIaffective response, selfother aware- being the only predictor with significant contribu-
ness, perspective taking, and emotion regulation tions individually. In the second model predicting
and controls for time in the social services field compassion satisfaction, 20 percent (R2=.24, ad-
overall, time in current position, and type of work justed R2=.20) of the variance was explained by
performed in current position (direct practice, the model [F(8, 140)=5.70, p<.01], with self
supervisory/administrative, or both). Current work other awareness [=.24, t(140)=2.45, p<.05] and
type (both direct practice and supervisory/admin- affective response [=.19, t(140)=2.50, p<.05] as
istrative) and current work type (supervisory/ the only significant predictors. The models for both
administrative) were created as dummy variables, burnout and compassion satisfaction varied signifi-
which were compared with a reference group cantly by time overall in a social services profession.
ofcurrent work type (direct practice). The depen- Those having been in the profession longer were
dent and independent variables are summarized in associated with lower levels of burnout and higher
Table1. levels of compassion satisfaction. In the third model,

Table 1: Descriptive Statistics for Independent and Dependent Variables


Variable N Range M SD
Selfother awareness component score 172 3.46 4.88 0.52
Emotion regulation component score 172 3.25.8 4.60 0.52
Affective response component score 172 3.26 4.30 0.48
Perspective taking component score 173 3.46 4.70 0.52
Years working as a social services professional 173 341 18.58 9.75
Years in current position 160 129 7.31 5.63
Compassion satisfaction (t score) 164 0.1763.93 49.76 10.11
Burnout (t score) 168 30.6276.79 49.81 9.69
Secondary traumatic stress (t score) 171 33.1285.43 49.61 9.59

Table2: Multiple Regression Analyses Predicting Social Worker Burnout, Compassion


Satisfaction, and Secondary Traumatic Stress
Model 1: Model 2: Compassion Model 3: Secondary
Burnout Satisfaction Traumatic Stress
Variable B (beta) B (beta) B (beta)
Intercept 105.70 5.57 77.15
Selfother awareness 3.21 (.17) 4.51* (.24) 4.87* (.26)
Emotion regulation 6.6* (.36) 3.00 (.16) 3.87* (.21)
Affective response 1.43 (.07) 3.92* (.19) 3.09 (.15)
Perspective taking 0.17 (.01) 0.20 (.01) 0.05 (.01)
Years as social services professional 0.16* (.16) 0.18* (.19) 0.02 (.02)
Years in current position 0.10 (.06) 0.01 (.01) 0.16 (.10)
Current work type (both direct practice and 1.39 (.06) 2.51 (.11) 0.18 (.01)
supervisory/administrative)
Current work type (supervisory/administrative) 0.85 (.04) 0.50 (.02) 3.42* (.17)
Adjusted R2 0.24* 0.20* 0.14*
F 7.12 (8, 142) 5.70 (8, 140) 4.34 (8, 145)
*p<.05.

Wagaman et al. / The Role of Empathy in Burnout, Compassion Satisfaction, and Secondary Traumatic Stress 205
with STS as the dependent variable, 14 percent tect social workers from decision-making patterns
(R2=.19, adjusted R2=.14) of the variance was that reflect poor boundary setting and maintenance.
accounted for [F(8, 145)=4.34, p<.01) with self Affective response, which was found to have sig-
other awareness [=.26, t(145)=2.65, p<.01] and nificant predictive value for higher levels of compas-
emotion regulation [=.21, t(145)=2.31, p<.05] sion satisfaction, is thought to work in concert with
as individually significant predictors. The model for the cognitive component of emotion regulation.
STS varied significantly by the type of work done. Unregulated affective response is seen as having the
Those in supervisory- or administrative-only posi- potential to create distress in an individual. The find-
tions had lower levels of STS than those in direct ings of this study suggest that affective response has
practice positions, all else being held constant. a positive relationship with compassion satisfaction.
The findings of this study indicate a significant Social workers may need to be able to share emotion
relationship between empathy and both compassion with clients. This process of affect sharing, while
satisfaction and compassion fatigue among social often contextualized in terms of trauma and pain,
work practitioners. Selfother awareness and emo- would also include sharing in a clients joy and suc-
tion regulation, which are cognitive components of cesses. Such affect sharing may be important to the
empathy, appear to be significant contributors to maintenance of a feeling of satisfaction in ones work,
components of compassion fatigue as compared with which is linked to a lower risk of compassion fatigue.
the other components of empathy. In contrast, af- Emotion regulation, a cognitive component of
fective response, which is a physiological component empathy, and its association in this study with burn-
of empathy, was identified as a significant contribu- out and STS suggest that the ability to regulate the
tor to compassion satisfaction. These findings do not emotional responses to clients that are physiological
vary significantly by time in the current position. in nature equips social workers to protect themselves
from repeated exposure to those who have experi-
DISCUSSION enced pain and trauma. Emotion regulation is a skill
The findings of this study suggest that there is a that can be learned and honed through training.
significant opportunity to use empathy in the prep- The identified relationship between the type of
aration of social work practitioners to cope with the work (direct versus administrative or supervisory
factors related to burnout and STS. The study find- practice) and STS is an important reminder that
ings also suggest that empathy may be a factor con- supervisors who move out of engagement in direct
tributing to the maintenance of the well-being and client contact need to remain aware and sensitive to
longevity of social workers in the field. the vulnerability of their supervisees to developing
It is important to explore the specific components STS. From an organizational perspective, this may
of empathy for which there was a significant predic- suggest a need for supervisors to maintain some di-
tive value, to understand the relationships that they rect client work or engage in empathy-related train-
suggest. Selfother awareness is a cognitive compo- ing to better understand the experiences of their
nent of empathy that emphasizes the ability to sep- supervisees.
arate oneself from others, including ones thoughts Finally, the fact that the relationships identified
and feelings, which is the process of setting and between empathy and burnout and compassion sat-
maintaining boundaries. The results of this study isfaction varied significantly by time in the profes-
suggest that attention to specifically training social sion is an important finding, particularly given that
workers in selfother awareness, both before enter- more years in the profession overall was associated
ing the field and while in the field, could serve as a with lower levels of burnout and higher levels of
protective factor against STS. Similarly, the relation- compassion satisfaction. This finding suggests that
ship between selfother awareness and compassion social work professionals can learn from strategies
satisfaction, as indicated by the findings, suggests used by long-term social workers that prevent burn-
that selfother awareness training may help to pre- out and maintain compassion satisfaction. Clearly,
vent burnout and STS by increasing compassion burnout can be prevented and managed across ones
satisfaction. Empathy can help social workers main- professional career. Given that issues of retention
tain professional boundaries by training them to be are important in the profession, this finding has
mindful of selfother awareness and emotion regula- important implications for intervention with social
tion in their everyday practice, which may also pro- workers, particularly in those areas of the profession

206 Social Work Volume 60, Number 3 July 2015


found to be a greater risk for burnout and STS, such Training in these techniques can be pursued by
as child welfare (Sprang, Craig, & Clark, 2011). individual social workers, as well as by organizations
Identification of practice settings with increased risk and human services systems. Such training may also
of burnout, STS, and turnover may provide direc- be incorporated into continuing education require-
tion for targeted efforts to enhance social workers ments for license renewal as a way to emphasize its
empathy where there is greatest need. importance throughout ones career. The findings
of this study suggest that future research should fur-
Study Limitations ther examine the relationships between empathy
Primary limitations of this study are that the sample and the components of compassion fatigue over
was drawn from one community and was fairly ho- time and in diverse samples, as well as explore indi-
mogenous in terms of race and gender, limiting gen- vidually oriented and organizationally oriented
eralizability. Second, despite our attempts to identify interventions designed to prevent or minimize ex-
the type of work and context, the data were not able periences of burnout and STS. Empathy is an im-
to differentiate between those whose work direct portant factor that can be incorporated into a dually
ly exposed them to crisis, those whose work di- focused intervention.
rectly exposed them to trauma, and those whose Social workers are vulnerable to burnout and
work directly exposed them to both crisis and trau- STS. This study demonstrates that empathy is a vi-
ma on a regular basis; or between those who worked able skill and strategy in buffering against the nega-
in supervisory positions and those who worked in tive effects of compassion fatigue and may increase
strictly administrative positions. No data were col- compassion satisfaction, longevity, and personal and
lected on environmental factors that the research professional well-being. Empathy can and should be
literature suggests may contribute to burnout, com- explored, cultivated, taught, and learned in formal
passion satisfaction, and STS, such as workload; per- educational settings, professional development pro-
ception of support for setting boundaries and grams, and continuing education for social workers
engaging in self-care; and having positive, supportive to improve work with clients, self-preservation, and
relationships with ones supervisor and colleagues. And organizational outcomes.
finally, given the cross-sectional nature of the study,
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208 Social Work Volume 60, Number 3 July 2015


Zimering, R., Munroe, J., & Gulliver, S. B. (2003).
Secondary traumatization in mental health care
providers. Psychiatric Times, 20(4), 4347.

M. Alex Wagaman, PhD, MSW, is assistant professor, School


of Social Work, Virginia Commonwealth University, 1000 Floyd
Avenue, PO Box 842027, Richmond, VA 232842027;
e-mail: mawagaman@vcu.edu. Jennifer M. Geiger, PhD, is
postdoctoral fellow, Arizona State University, Phoenix. Clara
Shockley, MSW, LCSW-C, CPC-AD, is a doctoral student,
Virginia Commonwealth University, Richmond. Elizabeth A.
Segal, PhD, is professor, Arizona State University, Phoenix.
Original manuscript received June 18, 2014
Final revision received September 15, 2014
Accepted September 22, 2014
Advance Access Publication May 1, 2015

Wagaman et al. / The Role of Empathy in Burnout, Compassion Satisfaction, and Secondary Traumatic Stress 209

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