Although most of us employ the terms empathy and compassion interchangeably, professional writers generally distinguish between these closely linked behavioral ideals. Specifically, they regard empathy as the capacity to put oneself in another’s shoes, which involves not only vicariously experiencing their perspective, but also its corresponding emotions. Compassion, however, is viewed as including all the components of empathy, but taking this imagined identification one crucial step further.
Literally meaning “to suffer together,” it focuses more on the willingness to actually take action to alleviate another’s suffering. In fact, eminent psychologist Barbara Fredrickson has dubbed it “empathy in action.” And such proactive efforts may register physically as a decelerated heart rate; secretion of the bonding hormone, oxytocin; and involve regions of the brain associated with caregiving. Additionally, because self-disinterestedly advocating for another’s welfare can be intrinsically rewarding, acting compassionately can also light up the pleasure centers of one’s brain (see “What Is Compassion?” no author or date provided, Greater Good Magazine, Univ. of CA, Berkeley).
Some writers investigating the negative ramifications of overdoing one’s endeavors on another’s behalf have labeled the phenomenon “empathy fatigue.” But most writers employ the term “compassion fatigue” (see, especially, Figley, 1995). And this preference may be because the latter designation suggests that people who go overboard with their compassion are more likely to “take on” the pain of those they’re so laboriously attempting to assist. On the contrary, empaths may endeavor to accurately “take in”—both cognitively and emotionally—the experience of the people they’re intimately identifying with, yet without the same arduous effort. And so they’re somewhat less vulnerable to the emotional exhaustion that comes from a more compassionate involvement with the sufferer.
The Benefits of Empathy and Compassion
This quotation probably says it best:
"Many of the world’s wisest people have stated that giving to others in life is the source of the greatest contentment and life satisfaction." (No author or date given, “Sympathy vs. Empathy vs. Compassion,” in OperationMeditation.com.)
Moreover, another person trusting us enough to take us into their confidence and share some of their most vulnerable, even traumatic, experiences can feel like an honor. (And as a therapist, countless times it’s certainly felt that way to me.) As attentive listeners, such intimate disclosures can also afford us the opportunity to expand our “felt knowledge” of what we may be able to relate to only vicariously, at a remove. And in being made privy to the most intimate, and sometimes scary, details of another’s life, we can broaden our compassionate understanding of the nature and scope of human existence.
Such sharing makes us more “feelingly” aware of what we’ve never had to go through ourselves. And if we’re called upon in the future to do so, we’ll be that much better prepared, emotionally, to handle the ordeal. Because in our head—and even our body—we’ve already rehearsed such a contingency. In short, empathically relating to what another has shared can increase our humanity and deepen our feelings of connectedness.
The Burdensome Costs of Caring: Compassion Fatigue and Vicarious Traumatization
So who’s in the greatest danger of empathy, or compassion, fatigue? It could be anyone whose native empathic supply is constricted, or it could be someone who’s taken on the onerous responsibility of dealing with massive pain and grief. In an essay entitled “Running on Empty,” Françoise Mathieu suggests the potential perils of overextending oneself for others by quoting the words of Rachel N. Remen (1996):
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.
Not surprisingly, people in the counseling profession are especially susceptible to exhausting their empathic resources. In a piece called “Empathy Fatigue” (2013), Lynne Shallcross notes that the counselor-client relationship demands “intense and compassionate listening.” And what, specifically, counselors need to closely attend to—and empathically identify with—is the unsettling “woundedness” portrayed to them not by just one, but by many of their troubled clients.
At some point, deliberately seeking to relate to so much shared misery can take its toll on counselors. For their efforts to fully “be there” for their clients have their limits and can reach a stage of exhaustion. When that limit is reached, emotional fatigue sets in, and resilience and coping capacity (whether at work and/or at home) will be compromised. In short, people in the helping professions are at special risk for getting wounded themselves. Or re-wounded, if empathizing with their clients’ pain (physical, mental, or emotional) ends up compelling them to revisit their own earlier psychological disturbances—which, never having been totally rectified, still carry a negative charge.
Other professionals highly subject to empathy/compassion fatigue include:
- Nurses, especially those struggling with heavy caseloads, working with terminally ill patients, or having to restrain themselves from reacting negatively to verbally aggressive or hostile patients
- Journalists who cover wars and disastrous events where they’re frequently in close proximity to widespread, horrifying trauma
- Fire, rescue, and law enforcement employees whose jobs typically encompass dealing with extreme, emotionally stressful situations
- Lawyers whose practice necessitates their visiting accident scenes and exposing themselves to gory, graphic evidence, or who must regularly read or write up traumatic events (e.g., see Amy McNamara, “Empathy and Compassion Fatigue”)
- Caregivers for the elderly and impaired, particularly those whose resources are stretched to the max in caring for deteriorating Alzheimer’s patients
- And a miscellany of others—as suggested by Diane Cole in “The High Cost of Caring” (2017), which lists (besides some of those already mentioned) soldiers, first responders, humanitarian aid workers, and surgeons
As Cole with sad irony observes: “The more empathic and open to others’ pain the workers are, the more likely they will share those victims’ feelings of heartbreak and devastation.” Or—as Jordan Rosenfeld (“Emotional Exhaustion: Is Empathy a Choice?” 2016) quotes Jamil Zaki, a social scientist at Stanford—an empathizing person can “take on the [negative] sensory, motor, visceral, and affective states” of another. Which is to say that, however admirable their efforts, caring deeply about those with whom one works can lead to repercussions no one would ever wish for.
Shallcross (2013) discusses how Carl Rogers, the originator of the person-centered approach to therapy, postulated that those clients who perceive their therapist as empathic are also the ones who show better outcomes as related to positive self-regard. And yet these therapists’ readiness to make themselves emotionally available is precisely what can at times threaten their ability to sustain this critical therapeutic resource. And that’s why not just therapists, but everyone in the healing/helping professions must make self-care as high a priority as caring for others.
Otherwise, having reached the limits of their empathy, their emotional labors can end up making them symptomatic—victims of what has been called secondary traumatization. As a multitude of writers have remarked, based on the particular individual and the degree to which they’ve strained their psychological resources, this distressful state can manifest not only as fatigue or exhaustion but also as apathy, numbing out, detachment and depersonalization, anxiety, sorrow, social withdrawal, guilt, anger and irritability, headaches, nausea and loss of appetite, weight loss or weight gain, dizzy spells, insomnia, intrusive images and flashbacks—and even a self-loathing or contempt tantamount to serious depression.
Fighting Compassion Fatigue: Tips for Self-Care
To reduce the odds that caregivers generally will become so emotionally overextended that they can no longer function competently, or contentedly, in their chosen roles, here’s a selection—as suggested by various writers—of proactive and reactive methods of self-care:
- Breathe. To feel calmer through inducing the relaxation response, engage in slow, steady, deep breathing, which will activate your stress-mitigating parasympathetic nervous system.
- Feel your body. When you’re in the presence of someone expressing strong emotions, guard against the emotional contagion your empathy renders you vulnerable to by feeling your feet on the floor and wiggling your toes. (This technique can be seen as getting out of someone else’s shoes and back into your own.) If you’re standing, bend your knees slightly; if sitting, feel your bottom in the chair. Be mindful of—without getting caught up in—all your bodily sensations.
- Set limits on your exposure to upsetting information. As much as feasible, carefully monitor how much time and attention you give to distressful stimuli. (Tara Well, 2017)
- As much as possible, reduce stressful workloads that are making you feel overwhelmed.
- Take regular vacations. And if that’s not tenable, practice some form of visualization, so that (at least in fantasy) you can retreat to your private, flower-filled meadow, secluded beach, or high-in-the-air mountain or cloud.
- Meditate to better assimilate and integrate your emotions—as well as achieve more distance from them.
- Journal. Give vent to—and more thoroughly process—whatever might be worrying or agitating you.
- Exercise regularly to stay healthy, restore your energy, and positively alter your emotional biochemistry.
- Talk to a trusted personal friend about what’s distressing you or seek therapy when you recognize that your work (whether mandated or volunteered for) is bringing up personal issues that, unresolved, require professional assistance.
- Make sure your diet is healthy—one that’s truly nourishing and promotes stamina and vitality.
- Reach out to support groups or networks.
- Generate a set of coping strategies customized to your individual needs and predilections (e.g., hiking, yoga, joining a band, prayer, or any spiritual practice that can help keep you “balanced” and restore your psychological equilibrium).
- Devote more time to hobbies you enjoy, which can divert attention from ongoing stressors at work.
- Do whatever you need to make sure you’re getting enough restful, restorative sleep. (Note: the 11 tips above are all adapted/expanded upon from the Amy McNamara article cited above.)
- As cynical at this may sound, it’s only prudent not to allow your empathy to run away with—or rather, from—you. As S. D. Hodges and K. J. K. Klein at the University of Oregon observe: “By regulating exposure and effort, people can to some degree regulate the amount of empathy they feel and, in turn, control [its] resultant costs... It may be more noble to be consistently empathic, but it is probably more adaptive to be variably empathic” (“Regulating the Costs of Empathy: The Price of Being Human,” 2001).
So—to conclude—to care best for others, be sure to take the best possible care of yourself.
NOTE: Directly complementing this piece is an earlier post of mine entitled: “On Listening—Take It In, Don’t Take It On.”
© 2018 Leon F. Seltzer, Ph.D. All Rights Reserved.