Derik Moore's job defined stressful. When he worked as a Philadelphia Department of Human Services investigator, he was the one who talked to children who had been abused, sometimes sexually, and confronted their abusers.
But he was handling it OK, Moore thought, triumphing when he made a difference, and accepting "a baseline melancholy" as part of life.
"Then my dentist says, 'You're grinding the hell out of your teeth,' " Moore said.
Stress in the body, stress at home, distance from loved ones, ulcers, high blood pressure: it all comes from "compassion fatigue," and for the 50 counselors and therapists attending a workshop Wednesday on "Stress Management & Self Care in the Field," Moore's story rang all too true.
"We have to be healthy for ourselves," said therapist and speaker Akia Feggans, who led the workshop - one of more than 42 sessions at Wednesday's Beyond the Walls Prison Healthcare and Reentry Summit.
The Summit, attended by 1,100 at the Pennsylvania Convention Center, was organized by Philadelphia FIGHT Community Health Centers, a 160-employee health group caring and advocating for people with HIV/AIDS.
"This conference is focused on the intersection of health disparities and mass incarceration," said Hannah Zellman, program director for Philadelphia FIGHT'S Institute for Community Justice and the organizer of the event.
Sessions included workshops on criminal records, strategies for protecting the health of drug users and the effect of incarceration on families.
Many of the same social pressures - poverty, homelessness and racism - that lead to people getting HIV also lead to incarceration, Zellman said.
These pressures produce burnout, stress and anxiety among caregivers and counselors who deal with the fallout, said Feggans, director of behavioral health at a Philadelphia FIGHT clinic.
The workers, she said, suffer from vicarious trauma as they try to pull their clients back from traumatic situations.
One worker described watching a 12-year-old with homicidal tendencies handcuffed and led away. She went into her office and cried for 20 minutes.
"It's so difficult not to be judgmental," said another counselor, who works with addicted mothers so eager to take their newborns home that they don't understand their infants must go through withdrawal in the hospital.
"This is a child, not a doll you dress up," she said.
"Where exactly do I draw the line," asked Eric Sollenberger, a recovery specialist with the Mental Health Association of Southeast Pennsylvania. The people he helps are experiencing trauma so similar to his own that he has a hard time separating their lives from his.
"I go home and it doesn't leave me," he said.
Feggans, and fellow panelist Jessica Bowers, a captain with the Philadelphia Department of Prisons who runs its employees assistance program, said workers have to learn to care for themselves.
"It's important not to keep it bottled up," she said.
The first step is recognizing compassion fatigue, and acknowledging burnout, along with feeling overwhelmed.
It can be as simple as "take your lunch, get out of your office," said Feggans. It can be talking to supervisors or colleagues to burn off steam.
Outside of work, it can be the deliberate pursuit of pastimes that heal, including talking to a spiritual adviser. Prevention also helps, with some at the session urging their colleagues to develop what is known as a "wellness recovery action plan."
Feggans said that supervisors need to assist frontline workers by giving them breaks or organizing debriefing sessions.
"Show me someone who doesn't have personal feelings," Feggans said, "and I'll show you a sociopath."