Understanding Compassion Fatigue

Is it an inevitability or a preventable occurrence?

Posted Jul 15, 2020

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A therapist meets with a client.
Source: NoSystem Images/iStock

For most caregivers and others in the mental health profession who work with suffering individuals, it is a calling to do this work, not a career.  We want so desperately to be of help to others, to guide, to support, and to aid our clients in reaching their goals.  The desire to be of service can push us to work harder and care more, beyond what the term “empathy” may describe. How can we be more prepared to grapple with the effects of continued exposure to secondhand trauma, regardless of its intensity (big T or little t), and the ongoing fluctuations of our emotional environment that come naturally from being attuned to those we work with?

This phenomenon is known as compassion fatigue, or what I like to call “psychic exhaustion,” and is thought by some to be inevitable. At times, being a helper impacts us in ways for which we are not prepared.  But prepared we must be to continue providing support for those we treat. 

As participants in the field of helping others, we uphold sacred expectations. We utilize terms like “use of self,” or the idea that our internal emotional environment can be used to guide treatment. We aim to have “unconditional positive regard,” a phrase encompassing our intention to always feel positively towards our clients. We routinely call on empathy, putting ourselves in the shoes of our clients and feeling what they may be experiencing in order to be more effective in our interventions and genuine in our responses. 

Most careers don’t require that feelings or perceptions are part of the work process.  We uphold these expectations, but we are impacted by the stories we hear and the events we are present for, such as offering support during crises, life transitions, or simply witnessing abject grief. These experiences can culminate in internal emotional reactions that are felt throughout each session, shift, or interaction and the time between.

Compassion Fatigue Symptoms and Risk Factors

Firstly, knowing how to spot compassion fatigue will help to move us into action to get support or make necessary changes. Compassion fatigue is described in various works as including symptoms such as depression, anxiety, grief, sleep issues, higher rates of illness, and pessimism.  These symptoms and compassion fatigue itself are typically experienced as increasing over time rather than developing instantaneously.  

Who among professional caregivers are at the highest risk for developing compassion fatigue?   According to research from a 2017 Traumatology study by Lucy Maddox and David Turgoose, those with their own trauma history, with higher caseloads, and those whose empathy style is feeling distress in the face of client’s distress rather than the perspective-taking style of empathy. 

How to Manage It

What, then, can we do to improve our chances to maintain positive emotional and physical homeostasis in the face of challenges? Not only do we want to provide the best care and outcomes to our clients, but there must be a way to do so that does not negatively impact ourselves, the very tool we hope to use. 

As with many psychological issues faced today, mindfulness has been shown to be effective in preventing and combatting compassion fatigue, Maddox and Turgoose found. The simple awareness of our own internal state can help us make choices that will alter how we manage incoming stressful information. Mindfulness is a practice; the more we use it in our everyday lives, the easier it will be for us to access it when interfacing with clients. 

The same study revealed that meditation, a component of some mindfulness practices, has also generated positive outcomes on this front by allowing for increased stress tolerance and supporting resilience. The research also points to a variety of supports that may mediate compassion fatigue such as use of evidence-based practices (those interventions that have been studied and shown to be correlated with positive outcomes), the practice of self-care, and deriving pleasure from work.

Institutions can help by providing access to clinical supervision which, if done effectively, may not only improve a worker’s ability to spot compassion fatigue but may also prevent it by enabling individuals to have more awareness of their internal state. Supervisors are in a unique position whereby they can recommend additional support, such as therapy, to further mediate compassion fatigue’s effects when warranted. By cultivating trusting, effective supervisory relationships, clinical supervisors and the staff they mentor can have an honest, thorough exploration of session content and worker experience.

When compassion fatigue hits, we are at times too exhausted to make use of coping skills such as a self-care plan, or we can even lose awareness that we are in a less than optimal state. Preparation and prevention are thus key. Having effective supervision as well as a supportive work and social circle will help us if we fail to notice the signs of compassion fatigue. An established mindfulness practice such as meditation may prevent some of its effects. We can also take a look at the type of empathy we use (are we reacting and mimicking our client’s emotions, or taking perspective?), then make any necessary adjustments. Using evidenced-based practices such as Cognitive Behavioral Therapy and Dialectical Behavior Therapy and making good use of clinical supervision may also mediate the effects of, or even prevent, compassion fatigue.

As those providing support to others, we can choose to prioritize our own psychological needs to be of increased help to those we treat and to give ourselves compassion and empathy as we traverse the emotional environments of others.

References

Heaslip, K., Ray, S. L., White, D., Wong, C. (2013). Compassion Satisfaction, Compassion Fatigue, Work Life Conditions, and Burnout Among Frontline Mental Health Care Professionals. Traumatology, 19(4), 255-267.

Maddox, L. & Turgoose, D. (2017). Predictors of Compassion Fatigue in Mental Health Professionals: A Narrative Review.  Traumatology, 23(2), 172-185.