© (1996) Victoria Polin, MA, ATR, LCPC
Questionnaire: Directions: Circle either true or false to each of the questions listed below. You will not have to show this to anyone.
- T F Are you startled easily?
- T F Have you or one of your clients experienced intense fear(s) at work?
- T F Have you been experiencing feelings of helplessness while working with clients?
- T F Has anyone threatened your own personal safety on the job?
- T F Has any of your clients safety been in jeopardy?
- T F Are you preoccupied with recollections, images or thoughts that are related to your job?
- T F Do you have disturbing dreams relating to work?
- T F Do things trigger you at work that bring on thoughts that are disturbing?
- T F Do you avoid activities, places, people that remind you of the work you do?
- T F At times do you forget important facts relating to work?
- T F Do you have a tendency to avoid certain activities you use to enjoy?
- T F Do you feel detached and/or estranged from your co-workers?
- T F Do you have trouble feeling your feeling, or avoid feeling them?
- T F Do you feel like you will not have a normal life span?
- T F Do you have trouble going to sleep/staying asleep at night?
- T F Have you noticed an increase in irritability or outbursts of anger?
- T F Is there a change in your ability to concentrate?
Definitions (from The American Heritage Dictionary)
Burnt Out - A failure in a device attributable termination to burning, excessive heat, or friction. Physical or emotional
exhaustion, especially as a result of long-term stress. One who is burnt out, as from long-term stress.
- Endured or done by one person substituting for another.
- Acting in place of someone or something else.
- Felt or undergone as if one were taking part in the experience or feelings of another.
- Occurring in or performed by a part of the body not normally associated with a certain function(s).
- Victimization - To subject to swindle or fraud. To make a victim of.
- Compassion - The deep feelings of sharing the suffering of another, together with the inclinations to give aid or support or to show mercy.
- Fatigue - Physical or mental weariness resulting from exertion. 2. Tiring of effort or activity; labor. 3. The decrease capacity or complete inability of an organism, origin, or part to function normally because of an excessive stimulation or prolonged exertion. 4. Weakness in material, such as metal or wood, resulting from prolonged stress. To tire-out; exhaust.
- Fun - A source of enjoyment, amusement, or pleasure. Playful and often noisy activity. To behave playfully; joke.
- Humor- The quality of being amusing or comicical. The ability to perceive, enjoy, or express what is comical or funny.