Compassion fatigue is a paradox for counselors and others in the helping professions. As Alyson Carr a licensed mental health advisor and supervisor in Florida points out, this affects their ability to do exactly what motivated many of them to enter the United States field first place – empathically support those who are in pain.
Empathy and compassion are attributes that those in the helping professions are particularly proud to own and cultivate. However, these characteristics can make some professionals themselves more susceptible to trauma as they regularly observe and work with those who are suffering.
Jennifer Blough provides counseling services to other helping professionals as the owner of Deepwater Counseling, a private practice in Ypsilanti, Michigan. She says many of her customers experience compassion fatigue. One of her former clients, an emergency room nurse, experienced trauma every day. One day the nurse was treating a child who had suffered terrible physical abuse, and the child died shortly after arriving at the hospital.
This incident haunted the nurse. She had nightmares and intrusive thoughts about the child's death and abuse. She began to isolate herself so much that she had to resign from her job because she refused to leave her home. She couldn't even bring herself to call Blough. Instead, she just sent a text asking for help.
Blough, a Licensed Professional Counselor (LPC) and Certified Compassion Therapy Therapist, asked the nurse to come to her office, but the nurse said she was comfortable leaving home with only her dog with her. So Blough told her to bring her dog to the meeting. That got the nurse in the door.
From there, Blough and the nurse worked together to help the client deal with her trauma. Blough also taught the client to recognize the warning signs of compassionate fatigue so that she can use resilience, grounding skills, relaxation, crossing boundaries, gratitude, and self-compassion to keep her empathy from becoming unmanageable.
Definition of compassion fatigue
"One of the most important ways to help clients who may be struggling with compassion or empathy fatigue is to provide psychoeducation," says Blough. "A lot of people don't even know that there is a name for what they go through or that others go through the same thing."
Blough, author of To Save a Starfish: A Workbook on Compassion Fatigue for the Animal Welfare Warrior, failed to understand that she experienced compassion fatigue while working at a shelter and as an animal control officer before becoming a consultant. After feeling depressed, she decided she was weak and unsuitable for her job and eventually left the field entirely. It wasn't until she was in Graduate School for Counseling that she learned that there was a name for what she had experienced – compassionate fatigue.
According to the American Institute of Stress, compassion fatigue is "the emotional lagging behind or the stress of working with people suffering from the aftermath of traumatic events." This differs from burnout, a "cumulative process characterized by emotional exhaustion and withdrawal that is associated with workload and institutional stress and is not trauma-related."
While compassionate fatigue is the better known and most widely used term, there is some debate as to whether it is the most accurate. Some psychiatrists argue that people can never be too compassionate. Instead, they say, people experience empathy fatigue.
In an interview with CT Online in 2013, Mark Stebnicki described empathy fatigue as the result of a state of psychological, emotional, mental, physical, spiritual and professional exhaustion that occurs when the consultants' own wounds are constantly checked by their clients & # 39; Life stories of chronic illness, disability, trauma, grief and loss. & # 39;
April McAnally, a private practice LPC in Austin, Texas, is among those who believe people cannot have too much compassion. Compassion is about having empathy and feeling what the other person is doing, but we have a screen – an internal boundary – that protects us, says McAnally. "However, empathy can be limitless," she continues. “We can be overwhelmed by what the other person is experiencing. … So what actually tires us is empathy without the inner limit that is associated with compassion. "
As Blough puts it, “Empathy is the ability to identify with or experience another's emotions, while compassion is the desire to help alleviate suffering. In other words, compassion is empathy in action. "
McAnally, a certified compassionate fatigue expert, also suggests using the term secondary trauma. She finds it more accurately describes the emotional stress and dysregulation of the nervous system that her clients experience when indirectly exposed to the trauma and suffering of another person or animal.
Symptoms and risk factors
Anyone can be prone to burnout, but compassion fatigue most commonly affects caregivers and those who work in the helping professions such as counselors, nurses, social workers, veterinarians, teachers, and clergy.
Working in a job with a high frequency of trauma exposure can increase the likelihood of compassion fatigue, adds McAnally. For example, a nurse who works in a gynecologist's office may have a lower risk of developing compassionate fatigue than an emergency room nurse. Although both have the same job title, the impact and frequency of trauma in the emergency room will be higher, explains McAnally.
Counselors should also consider race / ethnicity and context factors when assessing compassionate fatigue. Racial injustices, to which marginalized populations regularly face, are a source of ubiquitous and persistent trauma, according to McAnally. And unresolved trauma increases the chances of someone experiencing empathy fatigue, she adds.
Carr, a member of the American Counseling Association specializing in complex trauma and anxiety, and Blough both believe in the collective trauma that arises from the COVID-19 Pandemic and Exposure to Repeated acts of racist violence and injustices can lead to collective compassionate fatigue for all helping professionals (if they have not already done so).
McAnally, a member of the Texas Counseling Association, a branch of ACA, says the current sociopolitical climate has also affected the types of customers she sees. Recently, more people identify as activists and affected citizens who want advice. She found that these clients experience the same symptoms of compassion fatigue as those in the helping professions.
Blough and Victoria Camacho, an LPC and owners of Mind Menders Counseling in Lake Hopatcong, New Jersey, say that symptoms of compassion fatigue can include:
Feelings of sadness or depression
fear
Sleep disorders
Changes in appetite
Anger or irritability
Nightmares or intrusive thoughts
Feelings of isolation
Problems at work
An obligation to work hard and long
Relationship conflicts
Difficulty separating work from private life
Reactivity and hypervigilance
Increased negative arousal
Lower frustration tolerance
Decreased sense of trust
A diminished sense of purpose or pleasure
Lack of motivation
Problems with time management
Unhealthy coping skills such as substance use
Thoughts of suicide
There are also individual risk factors. According to Camacho, a certified compassionate fatigue expert, those with large caseloads, those with limited or no support networks, those with a personal history of trauma or loss, and those who work in unsupportive environments are at greater risk of development Compassion fatigue.
Indeed, research shows a connection between lack of training and the likelihood of developing compassionate fatigue. Someone early on in their career who feels overwhelmed by their job and doesn't have adequate training and support could be at greater risk for compassion fatigue, says McAnally.
One assessment tool both Blough and Camacho use with clients is the Professional Quality of Life Scale, a free tool that measures the negative and positive effects of helping others who suffer from suffering and trauma. According to Blough, this assessment helps her better understand the levels of trauma exposure, burnout, compassion fatigue, and job satisfaction of her clients.
Regulation of body and mind
"Awareness of our emotions and experiences, especially in a mindful manner, can serve as a barometer to protect us from developing full-blown compassion fatigue," said Blough, ACA member and social justice advisor. a division of ACA.
Part of this awareness consists in taking into account one's own nervous system and the physical changes in one's own body. When someone experiences compassion fatigue, their amygdala, the part of the brain involved in the fight or flight response, triggers a little too quickly, McAnally explains. So your body can react as if it were in physical danger (e.g. racing heart, sweating, panic) when this is not the case.
When customers become dysregulated, McAnally advises them to use grounding techniques to remind themselves that they are safe. She often asks clients to look around the room, including turning over in their chairs, so they can see that there is nothing to worry about at that moment. She also uses the 5-4-3-2-1 technique, where clients use their senses to perceive things around them – five things they see, four things they hear, three things they feel, two Things they taste and one thing they smell.
Research has shown that practicing mindfulness for a few minutes a day can increase the size of the prefrontal cortex – the part of the brain that is responsible for emotional regulation, adds McAnally.
Blough often uses the square breathing technique to ground clients and get them to slow down. She will ask clients to take a deep breath while adding a visual component to form a square with their eyes. They breathe in for four seconds while their eyes scan from left to right. They hold their breath for four seconds while their eyes scan from top to bottom. They exhale for four seconds while their eyes scan from right to left. And they hold their breath for four seconds while their eyes move down.
Counselors can also teach clients to do a full body scan to self-regulate, suggest Blough and Camacho. This technique involves feeling tension throughout your body as you see movement from head to feet. If the person senses tension in an area, stop and slowly release it.
Camacho once had a customer who leaned forward and grabbed the arm of the chair they were sitting in while they were talking. She stopped the client and asked, “Do you notice that you are grasping the armrest? Why do you think you are doing this? "
The customer replied: "I wasn't aware of this, but I find it comfortable. I have the feeling that I am grounding myself."
Camacho, an ACA member who specializes in post-traumatic stress disorder, trauma, and compassionate fatigue in professionals serving others, used this as an educational moment to show the client how to ground himself while relaxing Has muscles. She asked the client to let go of the chair and instead run their fingers lightly over it and focus on its texture.
Carr finds dancing to be another useful intervention. “When we dance and move around, our brain is told that we are not in danger. [It] enables us to develop and strengthen the ability to regulate affects and to have a non-verbal, integrated body-mind experience, ”she explains.
Create emotional boundaries
Setting boundaries can be another challenge to help professionals. According to Blough, many of their customers feel guilty when they say "no" to a request. They often have the feeling that they have to take in another customer or animal. But she asks, at whose expense?
Blough reminds customers that saying no or setting a limit only means yes to another option. For example, if a client wants to schedule an appointment on Thursday evening at the same time that the therapist's child is having a soccer game, the client's no only means that the therapist is saying “yes” to their family and their own mental health.
Blough and McAnally encourage people to create routines to get away from work at home. For example, clients and consultants could listen to an audiobook or podcast on their way home, or meditate, take a walk, or even shower to mark the end of the work day, suggests Blough. "Anything that helps them clear their heads and enables them to be fully present for themselves or their families," she adds.
People can also set what Carr calls an "off switch" to indicate that work is done. This action can consist of simply closing the office door, washing your hands, or stretching. At the end of the day, Carr likes to move her computer in another room or in a drawer so it's out of sight and out of her mind. Then she takes 10 deep breaths and leaves work in this room.
Exercise self-compassion
"Because many helping professionals are highly motivated and committed, they tend to have unrealistic expectations and make high demands of themselves, even to the point of exhaustion," says Blough. "Low levels of self-compassion can lead to compassion fatigue, particularly symptoms associated with depression, anxiety, and post-traumatic stress disorder."
In other words, self-compassion is an integral part of helping people deal with compassion fatigue. “Self-criticism keeps our systems in a state of arousal that prevents our brains from functioning optimally,” notes Carr, “while self-compassion allows us to be in a state of loving, connected presence. Hence, it is considered to be one of the most effective coping mechanisms. It can provide us with the emotional resources we need to care for others, help us maintain optimal state of mind, and improve immune function. "
According to Kristin Neff, an expert on self-compassion, caregivers should generate enough compassion for themselves and the person they are helping so that they can stay in the presence of suffering without becoming overwhelmed. In fact, she claims that caregivers often need to focus most of their attention on giving themselves compassion so that they have enough emotional stability to be there for others.
People in the helping professions can focus so much on caring for others that they forget to give themselves compassion and neglect to provide for themselves. Blough often asks clients to tell her about activities they enjoy – those that distract them from work, help them relax, and make them feel like they have achieved something. Then she asks how often they participate in these activities. Customers often tell her, "I was doing it all the time before I became a professional caregiver."
She reminds them that they can only help others if they also take care of themselves. That means they need to take the time to get involved in activities that relax and recharge them. It is not a choice that they should feel guilty.
Self-regulating in the session
As a helper, counselors will probably experience symptoms of compassion fatigue at some point. This is especially true for clinicians who frequently see clients dealing with trauma, loss, and grief.
For McAnally, this experience came early in her career. During the internship she had a client with a complex trauma history who could not sleep at night. In return, McAnally woke up in the middle of the night worried about the customer. Knowing this was a warning sign, she reached out to her manager, who helped her develop a plan to reduce the risk of compassion fatigue.
It almost goes without saying that counselors should follow the advice they give their own clients: They should establish a self-care routine. You should seek your own advice and support. You should set boundaries and find ways to recharge outside of work. And they should practice self-compassion.
But consultants also have to find ways to regulate themselves during the meetings. "When you're tense and hearing all these difficult stories, you're at a much greater risk of becoming vicariously traumatized," says Blough. Self-regulation can provide some level of protection from occurring, she notes.
Blough often uses the body scan technique while in session. This way, she can calmly relax her body without attracting the attention of her clients. As she teaches relaxation skills to her clients, she does the skills with them. For example, she slows her own breathing while teaching clients guided breath work. That way, she relaxes with them.
McAnally also learned to be self-aware and to regulate her nervous system when she is in the session. If she notices that her heart rate increases and her stomach contracts when a client describes a painful or traumatic event, then she grounds herself. She orientates herself by wiggling her toes and noticing how it feels when her feet hit the ground. She also looks around the room to remind her brain that she is safe.
McAnally also uses internal self-talk. She will think, "I'm fine now." As with the body scan, this is a subtle measure clinicians can take to self-ground without the client even realizing they are doing it.
Help for the helpers during COVID-19
Recently, Carr received a text from a counseling mentor who has been practicing for 40 years that said, “I'm falling apart. I am lost. I don't know what to do, but sending a text to someone I trust felt right. Write or call if you can. "
Carr quickly put out his hand and her colleague said he had experienced a feeling of hopelessness that he had not had in many years. He worried about his customers and feared that he wouldn't do everything for them. He was also concerned about finances; Some of his clients had become unemployed because of the COVID-19 pandemic, and so he saw them free of charge. All of this took its personal and professional toll.
Prior to the pandemic, McAnally treated her symptoms of compassionate fatigue in part by reporting to other therapists working down the hall from her office and attending personal counseling groups. Now that she's been working full time from home because of the pandemic, she says she needs to be more focused on practicing self-care and having access to support. She calls her coworkers to check-in, practices mindfulness, and schedules breaks to go outside and play with her dog.
Even when counselors realize they need help, they may encounter obstacles similar to those of their clients. For example, they may not be able to find on-line providers and only a small portion of the hourly rate may be covered by their insurance. Because of this problem, Carr asked a few questions: “Who is helping the helpers right now? How can we take care of others if we cannot take care of ourselves more easily? "
Then she decided to take action. She founded Counseling for Counselors, a nonprofit dedicated to raising awareness of the emotional and psychological implications for mental health providers at a time of collective trauma. The organization aims to generate funding that will enable self-employed licensed mental health professionals in need of treatment to more easily access these services.
"While the heightened state of pandemic fear may have exposed this critical need, the demand for quality and affordable counseling psychiatric care remains," says Carr. “Counselors are not immune to trauma, and licensed mental health professionals now more than ever need access to mental health services to effectively treat the populations we serve and to continue to make an important contribution to the welfare of society at large. "
Promotion of satisfaction with compassion
People in the helping professions often feel guilty or ashamed of struggling with compassionate fatigue. They sometimes think they should be immune or find a way to assert themselves despite their symptoms. However, this is not the case.
“I think the greatest benefit of compassionate fatigue is that it is a normal, almost inevitable consequence of caring for and helping others. It is not a flaw in character or a sign of weakness. It's not a mental illness. It affects the best, the brightest, and those who care the most, ”says Blough.
Compassion fatigue isn't something you "have" or "don't have," she adds. Instead, it works on a spectrum, which is why it's so important to help professionals become aware of its warning signs and symptoms.
Blough admits that for her personally, compassion fatigue is always in some form. She often manages it well, so that it only simmers in the background. But sometimes it boils over. When that happens, she knows how to regulate, improve self-sufficiency, and get support.
For a negative experience, it is easy to overshadow the whole day of a helping professional and toss aside all positive aspects. For this reason, Blough and McAnally recommend taking time each day to list three positive things happening at work. A counselor or other helping professional could focus on the joy he felt as he saw an improvement in his client that day or when he experienced the "Aha!" Moment on her client's face.
Blough often advises customers to record or otherwise reflect on these positive experiences before bed, as this can help prevent rumination and intrusive thoughts that can disrupt sleep. Celebrating these "little victories" will help renew her passion for her job, she adds.
As Blough points out, “Empathy can definitely lead to compassion fatigue, but if handled properly it can also promote compassion satisfaction, which is the opposite of compassion fatigue. It is the joy you get from your work. "
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Lindsey Phillips is Counseling Today author and UX content strategist. Contact them at [email protected] or through their website at lindseynphillips.com.
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It should not be assumed that opinions or statements in articles appearing on CT Online represent the opinions of the editors or guidelines of the American Counseling Association.
