I. What is Compassion Fatigue?
We have heard terms such as stress, burnout and trauma for a number of years. In the past decade, new terms such as secondary trauma, vicarious trauma and compassion fatigue have also emerged. In some cases these terms seemed used interchangeably, but they do have important differences. As New Hope counselors we talk and chat with many people, such as nurses, first responders, social workers and care givers who may be suffering from compassion fatigue. Many of us may also have some symptoms of this syndrome, and we need to check on ourselves as well.
Charles R. Figley, Professor at the University of Florida who is known for his work with secondary trauma, says the following "The concept of Compassion Fatigue has been around only since 1992 when Johnson used the term in a nursing magazine. It fit the description of nurses working with hospital emergencies. "The dictionary meaning of compassion." Say Dr. Figley, "is a "feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause" (Webster, 1989, p. 229). Some would argue that it is wrong for a practitioner to have deep feelings of sympathy and sorrow for their client's suffering. And certainly practitioners must understand their limitations in helping alleviate the pain suffered by their clients." (Figley, Compassion Fatigue, 1995.) "Yet, most systematic studies of the effectiveness of therapy point to the therapeutic alliance between client and clinician, the ability to empathize to understand and help clients (Figley & Nelson, 1989). If it is not present, it is highly unlikely that therapeutic change will take place. The most important ingredients in building a therapeutic alliance include the client liking and trusting her or his therapist. And these feelings are directly related to the degree to which the therapist utilizes and expresses empathy and compassion."
II. How Does Compassion Fatigue Differ from Burnout?
Most of us are familiar with the concept of burnout, especially as it pertains to work. Too much work, stress, long work hours, and limited enjoyment can lead us to burning out on a particular job or type of work. For instance a tax consultant may reach a point of not wanting to deal with the stressors of tax season, but may still be able to do other work in his field. Compassion fatigue differs from this, in that it is actually the emotional state of the helping person that becomes affected. As we use empathy and open our hearts and feelings to others, we can be deeply affected by the trauma which they are experiencing. Over time we can reach a point of emotional fatigue which may affect our ability to be compassionate in all areas of our lives, not just our professions.
According to America's Continuing Education Network at www.acenetwork.com
"Compassion Fatigue is the emotional residue of exposure to working with the suffering, particularly those suffering from the consequences of traumatic events. Professionals who work with people, particularly people who are suffering, must contend with not only the normal stress or dissatisfaction of work, but also with the emotional and personal feelings for the suffering. Compassion Fatigue is NOT "burnout". Burnout is associated with stress and hassles involved in your work; it is very cumulative, is relatively predictable and frequently a vacation or change of job helps a great deal.
Compassion Fatigue is very different. Compassion Fatigue is a state of tension and preoccupation with the individual or the cumulative trauma of clients, as manifested in one or more ways including re-experiencing the traumatic event, avoidance/numbing of reminders of the event, and persistent arousal. Although similar to critical incident stress (being traumatized by something you actually experience or see), with Compassion Fatigue, you are absorbing the trauma through the eyes and ears of your clients. There are human costs associated with Compassion Fatigue. Job performance goes down, mistakes go up. Morale drops and personal relationships are affected- people's home lives start to deteriorate, personality deteriorates and eventually it can lead to overall decline in general health."
III. What Causes Compassion Fatigue?
Babette Rothchild, LCSW, ('Help for the Helper',W.W. Norton and Co., 2006) writes: "As therapists, empathy is our major, greatest, and most reliable tool. Often it is our capacity for empathy that brings us to the helping professions in the first place. Empathy allows us to relate to others in our care and to have a sense of what they are feeling. It also helps us to put their experiences into perspective, understanding how they are being affected by the incidents that we are trying to mediate. When we have an insight, and accurate hunch, or seem to read the client's mind, that may also be a result of empathy. Without it, we could not be the effective therapists that we are. Empathy is an integral, necessary tool of our work. For practitioners who consistently "bring their clients home", -consciously or unconsciously---the impact over time can be severe. We need not bring our clients home with us to qualify as compassionate or competent practitioners. In fact, the opposite may be the case. The better we take care of ourselves and maintain a professional separation from our clients, the more we will be in a position to be truly empathetic, compassionate and useful to them. Knowledge is power. The more you understand how you are affected by your clients, the more you will have the choice to maximize those effects when beneficial, and minimize them when they pose increased risks to your-or your client's well-being."
Daniel Abrahamson, Ph.D., a clinical psychologist and co-founder of the Traumatic Stress Institute/Center for Adult and Adolescent Psychotherapy, or TSI/CAAP, in South Windsor, Conn. says "Psychologists who work with patients who have suffered traumatic experiences must learn to balance objectivity and empathy. 'You can't become so hardened that it no longer affects you, because then you can't be there for the patient.' 'On the other hand, you can't be horrified and outraged to the point of being paralyzed.' 'It's not just dealing with everyday problems like getting motivated, looking for a job, working through relationship problems,' Abrahamson said.
Dr. Figley, head of the Psychosocial Stress Research Program at Florida State University, examines the problem in his book, Compassion Fatigue, 1995 "Hearing about past trauma can trigger haunting memories from a therapist's own past," Figley said. Based on his experience treating mental health professionals, Figley believes the providers more likely to suffer from compassion fatigue are those who are caring and empathetic.
"A debilitating weariness brought about by repetitive, empathic response to pain and suffering, compassion fatigue is a result of absorbing and internalizing the emotions of clients and, sometimes, coworkers, explains Karl LaRowe, MA, LCSW. It's an occupational hazard that may affect any professional who works day in and day out with those who are physically, mentally, or emotionally challenged or those who have been traumatized - whether by illness, violence or other tragedies."
"Compassion fatigue, says LaRowe, is nothing less than secondary traumatic stress, and its effects are much the same as those of posttraumatic stress disorder (PTSD). The signs and symptoms, he observes, at first tend to be psychological and emotional, but may soon become behavioral, physical, and spiritual (see side bar). The repercussions, both personal and professional, are costly. Compassion fatigue,' LaRowe explains, 'can result in distraction, hypersensitivity, overload, and misperception in our communications with self and others.' It frequently leads, he adds, to physical illness, and to the No. 1 ailment of caregivers: depression. LaRowe notes that the co morbid conditions most often associated with and closely related to trauma is depression."
"How does compassion become debilitating? Classic studies indicate that burnout develops in one of two situations: when people find that the job they do is not what they expected it would be or when there are not supportive relationships on the job", says LaRowe. "People who work with high exposure to the trauma of other people can find themselves in both of these situations. 'As care providers sit down with trauma survivors and open their hearts, over a period of time, they accumulate trauma,' he says. 'Many of us have chosen to go into the health profession in general, and to work with traumatized people in particular, because we've experienced trauma in our own lives.' By learning to transform compassion fatigue, helping professionals can reinvest themselves in their work and bring to it new energy and a renewed sense of purpose. By learning more about the condition and the methods for ameliorating it, they can also help their clients. Helping professionals who care for people who suffer from compassion fatigue themselves can use their knowledge to help these clients prevent or cope with compassion overload."
IV. How Do I know if I Have Compassion Fatigue?
In order to determine if you or someone you are counseling has compassion fatigue, the first clue is how you or they are feeling emotionally. If you are normally a compassionate person who likes to help others and you find yourself avoiding conversations involving other's feelings, or becoming cynical or apathetic about other's feelings, these could be important signs. If this seems to be occurring frequently, you may want to take a compassion fatigue test or inventory (available online at www.acenetwork.com) to assess if you are becoming stressed, burning out or developing actual compassion fatigue. It is possible all three may be occurring at one time."
V. How is Compassion Fatigue Overcome?
Home Health Care Clinical Notes Fall 2007 "Overcoming compassion fatigue: 8 Tips for Professionals-Francis Mathieu, M.Ed, CCC
"We believe that compassion fatigue is a normal consequence of working in the helping field. The best strategy to address it is to develop excellent self-care strategies. The following are eight strategies to help you transform compassion fatigue into compassion satisfaction.
1. Discover what's on your plate. You can't aim to make changes without knowing where the problem areas are. Take a nonjudgmental inventory of where things are in your life. Make a list of all the demands in your life. List the main stressors you see under each category. Once completed, see what stands out. What is making your plate too full?
2. Start a self-care idea collection. This can be fun and can be done with friends at work. Interview 3 friends on their favorite self-care strategies. Start making a list, even if they are not ideas that you would do or are able to afford at the moment. Something new might emerge that you hadn't thought of.
3. Rebalance your workload. Do you work straight through until lunch? Do you spend weekends running errands and catching up on your week? Can you think of simple ways to take mini breaks during a work day? This could be closing your door (if you have one) and listening to ten minutes if your favorite music during lunch. Make sure you do one nourishing activity per day. This could be a 30 minute bath with no one bothering you, going out to a movie, or taking 10 minutes to sit and relax. Take time when you can and make the most of it.
4. Ask for help. Are there things that you can let others do their own way?
5. Have a transition from work to home. Take a 20 minute walk through a beautiful park. Helpers have said that one of the best strategies for transition is to have a transitional ritual of some kind: putting on cozy clothes when you come home and having a 10-minute quiet time to change gears.
6. Learn to say no more often. Learn to set limits. Say yes to fun activities, friends and new opportunities.
7. Assess your trauma inputs. Do you work with clients who have experienced trauma? Do you read about, see photos of, and are exposed to difficult stories and images at work? Outside of work, how many difficult stories do you hear? (Including the news.) Create a trauma filter to protect yourself from extraneous material.
8. Exercise. Think of three small ways to increase your physical activity. Take the steps, do yoga, take short walks each day."
Family Practice Management April 2000
John-Henry Pfifferling, PhD, and Kay Gilley, MS
"To those who are in the throes of compassion fatigue, time, or more precisely the lack of it, is the enemy. To compensate, many physicians try to do several things at once (e.g., eat lunch while dictating chart notes and returning telephone calls). And to make more time, they tend to eliminate the very things that would help revitalize them: regular exercise, interests outside of medicine, relaxed meals, time with family and friends, prayer and meditation. At this point, they find it easiest to blame others. "If only," they lament. If only the staff, system, insurance carriers, administration or their colleagues did things differently, they'd have more time. And, no matter how much or how well they sleep, they still awaken exhausted.
To recharge your batteries you must first learn to recognize when you're wearing down and then get into the habit of doing something every day that will replenish you. That's not as easy as it sounds. Old habits are oddly comfortable even when they're bad for us, and real lifestyle changes take time (some experts say six months), energy and desire.
Yet, if you're compassion fatigued, getting back in touch with yourself is perhaps the most important step in the recovery process. Without it, the lifestyle changes you're trying to make may not be enough to sustain you.
It helps to have someone to talk to who is a good listener, understands compassion fatigue, and with whom you feel a connection. This person is usually a professional counselor, but a colleague with firsthand knowledge of compassion fatigue, a pastor, or a spouse or friend who can listen without judging or offering solutions to your problems are other alternatives. A well-facilitated physician support group, although sometimes difficult to find, is also an immensely safe place. Colleagues who have learned to listen deeply can offer you caring and innovative options based on their own experiences.
The lifestyle changes you choose to make will depend on your unique circumstances, but three things can speed your recovery.
1. Spend plenty of quiet time alone. Learning mindfulness meditation is an excellent way to ground yourself in the moment and keep your thoughts from pulling you in different directions. The ability to reconnect with a spiritual source will also help you achieve inner balance and can produce an almost miraculous turnaround, even when your world seems its blackest.
2. Recharge your batteries daily. Something as simple as committing to eat better and stopping all other activities while eating can have an exponential benefit on both your psyche and your physical body. A regular exercise regimen can reduce stress, help you achieve outer balance and re-energize you for time with family and friends.
3. Hold one focused, connected and meaningful conversation each day. This will jump start even the most depleted batteries. Time with family and close friends feeds the soul like nothing else and sadly seems to be the first thing to go when time is scarce.
Don't make big decisions. We advise our compassion-fatigued clients not to make any major life decisions until they've recovered physically, emotionally and spiritually. This is perhaps the most important advice we can give. Don't quit your job, get a divorce, have an affair or spend your money on a lavish trip or a new sports car. It may feel great at the time, but a few days or weeks later you'll find yourself waking up to the same set of problems.
Don't blame others. Similarly, blaming administration, staff, colleagues or the "system" will do you no good. Being adversarial will only exhaust you further and prevent the deeper healing that needs to take place. The same goes for looking for another job. Wait until you can see things more clearly and have gotten the stress in your life under control.
Don't spend your energy complaining. We also advise that you avoid commiserating with discontented colleagues. You've heard the old saying "misery loves company." It's easy to fall into the habit of complaining when you're consumed by compassion fatigue, but it will only make you feel worse. There are other, more constructive environments to share your feelings.
Don't try a quick fix. Compassion fatigue can make you vulnerable to addictive behaviors and substance abuse. We've seen many clients try to deal with compassion fatigue by working longer and harder. Others self-medicate with alcohol and prescription drugs. There are a whole host of other addictive behaviors, including sex, that are used to relieve personal pain. Don't let yourself abuse work, alcohol or drugs and don't fall prey to a quick fix. Just as drugs can be addictive and eventually cause a whole different set of problems, the quick fix almost always ends up complicating an already overburdened escalating the downward spiral.
Dr. Pfifferling is director of the Center for Professional Well-Being in Durham, N.C., which specializes in physician stress management. He is also a clinical associate professor at the University of North Carolina, Chapel Hill.
Kay Gilley is chief executive officer of Intentional Leadership Systems in Durham, N.C., and an associate of the Center for Professional Well-Being.
As New Hope counselors we are especially vulnerable to compassion fatigue. We have no ability to predict what is coming in the next call or chat and we must constantly shift from setting good boundaries to being open and compassionate to the needs of others. We will talk or chat with as many as 12 different people in distress in just one four hour shift, far more than the average therapist.
As helping professionals, we are often focused on the needs of others to the point where we forget the importance of self-care. We tend to "run on empty," may not rest enough, eat the right foods or get enough exercise on a daily basis. Because we are empathetic and caring, the problems of our chatters and callers may touch us deeply. We need to remind ourselves that if we are really going to be able to care for others, we must learn to take care of out own physical, emotional and spiritual needs first. Most of us love helping others, and we must develop an emotional resiliency if we are to keep from burning out our most important tools: compassion and empathy.
