Compassion fatigue

Compassion fatigue is a serious impediment to therapist wellness and can cause a well-intended clinician to become largely ineffective. It is a psychotherapist’s job to provide clients with a sympathetic shoulder to lean on, but what happens when a practitioner’s compassion works against them? In 1992, nurse Carla Joinson coined the term “compassion fatigue” to describe what happens to helping professionals when they take on their clients’ emotional burdens. For such a significant problem, it is not widely discussed. Further investigation is warranted: What is compassion fatigue and what can therapists do to prevent it?

What is Compassion Fatigue?

Psychologist Charles Figley - one of the leading researchers of compassion fatigue - described the condition as “a state of exhaustion and dysfunction, biologically, physiologically and emotionally, as a result of prolonged exposure to compassion stress.” Although it was initially explored in professionals who treated trauma, it has become clear that it can develop in any person who must cope with other people’s problems on a consistent basis.

Signs and symptoms of Compassion Fatigue

The following are indicators of compassion fatigue:

• Emotional numbing: Ironically, one of the main symptoms of compassion fatigue is a dulling of the ability to feel compassion and empathy. It is as if your body just can’t take any more emotions and shuts itself off. The danger for therapists is that they may become desensitized to the experiences of others and have difficulty connecting to clients.

• Secondary traumatic stress: People who treat trauma often develop secondary trauma symptoms themselves. These may include insomnia, physical symptoms, (e.g., racing heart, shortness of breath, tension headaches), and excessive fear and worry that appear irrational to others.

• Burnout symptoms: Although compassion fatigue is not the same as burnout, it shares some of the same symptoms, including exhaustion, irritability, and job dissatisfaction.

• Self-medicating: Clinicians with compassion fatigue are more likely to self-medicate to cope with the condition, leading to the possibility of substance abuse. Because therapists are looked upon as pillars of reason and good judgment, this is especially concerning.

Watch Your Free On-Demand Webinar: 9 Admin Tasks to Automate In Your Private Practice

Who is most at risk?

The factors most associated with compassion fatigue include:

• Experiencing trauma: A professional’s history of traumatic life events was most highly related to developing compassion fatigue. This makes sense when you think that someone who has experienced trauma is more easily triggered by hearing about other people’s suffering.

• Mindfulness: Dispositional mindfulness appears to play a protective role against compassion fatigue. It refers to a person’s innate ability to pay attention to the present moment while possessing a non-judgmental attitude. This is not to be confused with practicing mindfulness, which is an activity rather than a personality trait. However, it follows that a regular mindfulness practice will likely lead to more dispositional mindfulness.

• Empathy: People higher in empathy are more at risk for compassion fatigue. By definition, empathic people can put themselves in another’s position, thus exposing them to a barrage of difficult emotions. While empathy is a desired characteristic in a therapist, it leaves a person more vulnerable to stress.

• Workload: As you might suspect, a higher caseload is associated with more compassion fatigue. This is especially true for professionals who regularly treat clients who deal with traumatic backgrounds. More work brings on more stress and leaves therapists more susceptible to compassion fatigue.

• Sense of achievement: Sense of achievement is the extent to which the therapist is satisfied with their efforts to help the client. A clinician with a sense of achievement is going to be less likely to develop compassion fatigue because they will not be constantly worrying about what they could be doing better.
  • Are you at risk for compassion fatigue and experiencing some of the above symptoms? The Compassion Fatigue Self-Test (CFST) is a quick assessment measure to screen for compassion fatigue.

Key strategies for prevention and coping with Compassion Fatigue

If you are worried about compassion fatigue or believe you may already have it, here are steps you can take to combat it:

• Setting boundaries: Setting firm boundaries is important for any clinician but this is especially true when you are dealing with clients experiencing difficult mental health problems. Implementing strong boundaries takes two forms.

First, you must not allow a client to become personally involved in your life. You are less likely to take on their stress if you keep the relationship purely professional. Next, is the ability to disengage emotionally from cases after you leave the office. Being able to let go of work and not ruminate about clients’ troubles during your free time is critical to a therapist’s health.

• Self-care: Self-care is a buzzy topic among therapists these days and it can mean different things to different people. For our purposes, the most important self-care you can perform involves three areas: healthy eating, regular exercise, and consistent sleep. If you focus on achieving these three pillars of health you will be well-equipped to fight against compassion fatigue. After all, you can’t help others if you don’t help yourself.

• Emotional outlets: Outlets are a healthy way to de-stress and re-energize. For example, you could go to a yoga class, take a dancing lesson, or spend some quiet time drawing. Not only do outlets provide a way to cope with stress, it is more difficult to focus on client problems when you are absorbed in other activities.

• Relaxation/Mindfulness: Relaxation and stress are opposites. If you are in a state of relaxation, you are not worrying about your—or your clients’—troubles. Practicing mindfulness takes it up another notch. Yes, mindfulness can be relaxing on its own but it is especially helpful because it allows you to focus on the moment without judgment rather than think about your work.

Download My Free Practice Mindfulness Worksheet

• Work limits: Setting appropriate work limits will reduce your susceptibility to compassion fatigue. This means limiting your caseload and saying no when you feel overburdened. This is much easier if you are your own boss in a private practice. If you are part of an institution, you may have to talk to a supervisor for assistance in managing your workload.

• Supervision and peer support: Every therapist needs support from a colleague that understands what they are going through. This can take different forms. Some therapists might informally talk about cases with peers or have a peer group supervision session. Others may want formal supervision from a more seasoned therapist. The ability to consult with other professionals is a valuable resource. Other therapists may see signs of compassion fatigue that you miss and be able to provide valuable advice.