Special Report: Transforming Compassion Fatigue: Regain your Passion for Compassion!

Introduction

Transforming Compassion Fatigue: Regain your Passion for Compassion, is a special report written for the social workers who work at family service agencies, on the front line with clients who are experiencing financial, social and family hardship, the counselors working with mental health organizations providing care and guidance to thousands of people struggling with the emotional challenges of a rapidly changing society, the doctors and nurses in a rapidly changing and demanding healthcare profession and the many others who work in education, corrections, and other public and private organizations.

The essence of Transforming Compassion Fatigue: Regain your Passion for Compassion is about how to regain and maintain your positive energy as a healthcare provider. We will examine what compassion fatigue is and how you can become more aware of how it affects you before it drains your energy and robs you of your passion for your work.

What is Compassion Fatigue?

Compassion fatigue has been defined as: “The reduced capacity or interest in being empathic or ‘bearing the suffering of clients’ and is ‘the natural consequent behaviors and emotions arising from knowing about traumatizing events.’” [1]

Compassion fatigue is a state of physical and emotional exhaustion from repeated empathic engagement with people who are suffering. It is both tired from caring and even tired of caring. It is the “natural consequent emotions and behaviours” that often result from the work we do.

Compassion fatigue, also called vicarious traumatization or secondary traumatization is the emotional residue or strain of exposure from working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Risk for Compassion Fatigue

Research indicates: “Healthcare professionals working with traumatized patients were at greater risk for CF, controlling for demographic factors, personal trauma history, social support and work environment factors…We suggest that the important variables in predicting CF include degree of exposure, personal history, social support, and work environmental factors.”[3]

Why would working with traumatized patients increase your risk for compassion fatigue?

Personal Trauma

It is believed that the secondary exposure to trauma from having an empathic, helping relationship with someone who is experiencing physical, medical, emotional or situational trauma can unconsciously trigger responses within your brain through a neural-psychological mechanism known as mirror neurons.[4] In essence, your brain and nervous system can literally mirror the physical and emotional responses of your client.

What the studies on mirror neurons also showed was, the more similar life experiences you have with your client, the more you are likely to mirror their responses.

What this means is, if I have personally suffered physical or emotional abuse I am much more likely to mirror my client who is suffering abuse in a more intensive way than someone who hasn’t had the same experiences.

In fact, personal trauma history is one of the most important factors in predicting a person’s vulnerability to compassion fatigue. It’s a two-edge sword. Personal history of trauma can make helpers much more empathic with their clients and effective as helpers, it can also render us more vulnerable to compassion fatigue.

Degree of Exposure

Other factors brought out by the research that have a bearing on how much helpers are vulnerable to compassion fatigue are degree of exposure, social support and work environment.

Degree of exposure refers to how many clients who are suffering from trauma you are working with in a day, a week, over the course of a career. It also refers to the intensity of the trauma one is exposed to.

Social Support

Social support refers to how much support you receive from your professional, personal and family network. It is now being recognized how crucial it is to have a professional support network because it can be difficult for family and friends to understand the nature of trauma that you are exposed to at work.

Working Environment

This brings us to the work environment which is one of the most critical and yet overlooked factors that can either contribute or mitigate and prevent compassion fatigue.

Research now shows that a safe, supportive working environment is crucial to mitigating and preventing compassion fatigue. As Rosenbloom, et.al [5] states:

“Prevention of potentially harmful effects from CF involves attention to both concrete issues, such as provision of supervision and adequate time off, as well as to less tangible sources of support, such as the organizations attitude toward the impact of trauma on helpers.”

Transforming Compassion Fatigue

Transforming compassion fatigue requires both awareness and action. Awareness begins with becoming conscious of those situations in which we are more likely to mirror the emotions of our clients so that we can take effective action to transform rather than internalize the stress.
Self-awareness is a core competency of emotional intelligence [6] and is defined as: “recognizing the feeling as it happens.” This means that we begin to follow some of the advice that we so readily give to our clients and start listening to our own feelings before, during and after we sit with our clients.

Prepare for Each Session

Preparing for each session with every client regardless of who they are or what their presenting problem might be is essential to being effective as well as maintaining our own emotional health. The simple fact is we don’t know what is going to happen in any given encounter with another person.

Preparing for each session means taking a moment to pause, relax and reflect before engaging. It means “having your head in the game” before you encounter your client. We are most vulnerable to mirroring and absorbing stress from our clients when our mind is somewhere else and we are not conscious, present and focused on what we are doing.

Being “Present”

Next, is to be conscious and present when you are with your client. This may seem like a “no-brainer” but you might be a little shocked by how often we actually “check-out” as we are “listening” to our clients.

This may be because we have already had a stressful day and have absorbed as much as we can take for one day and are not in a receptive frame of mind. Everyday stress can and does accumulate in our body and mind to the extent that it can affect how open and receptive we are to hearing other people’s problems.

Discharge and Re-charge

One of the strategies taught in the workshop is how to discharge the accumulation of daily stress. Day after day of “ordinary” stress in combination with secondary traumatic stress from our clients is a recipe for compassion fatigue and burnout. After each session take a couple of minutes to “discharge” the “energy residue” of the session and “re-charge” your energy through stretching, breathing, relaxing or some other conscious self-care activity (for more see articles on Techniques for Transforming Compassion Fatigue).

Conclusion

Compassion fatigue is a natural reaction to the work that we do. It is not pathological. It does not mean that we don’t care. It is the result of empathic engagement with people who are suffering. Over time, it can result in being “tired from caring, even tired of caring.”

We can learn to transform compassion fatigue by recognizing the signs and taking action by preparing for each session, being more present when we are with clients, discharging the energy residue and recharging our energy. By learning to care for ourselves we become more effective in caring for our clients.

Notes:

1. Compassion Fatigue Following the September 11 Terrorist Attacks: A Study of Secondary Trauma among New York City Social Workers: International Journal of Emergency Mental Health, Vol. 6, No. 2, 2004
2. Figley C.R., “Compassion Fatigue, Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized.
3. Ibid
4. The Mirror-Neuron System: Annual Review of Neuroscience (2004) 27: 169-192
5. Rosenbloom, et al: Helper’s response to trauma work: Understanding and intervening in an organization
6. Goleman, D. “Emotional Intelligence: Why it can matter more than IQ.” Bloomsbury (1995).
7. A term coined by Dr Peter Levine in Waking the Tiger, Healing Trauma for accumulated trauma energy that takes root in the nervous system.

Principles for Transforming Compassion Fatigue

Introduction:

In my seminars on: “Transforming Compassion Fatigue Into Flow and Peak Performance,” I share three basic governing principles of the Healer-Warrior philosophy. These principles provide the foundation for each seminar and have been a guiding light for my own personal transformation; Self-honesty, personal responsibility, and self expression.Each of these principles contains elements essential to the process of personal transformation.

Courageous Self-honesty

Self-honesty is the key. It is the primary, essential process that allows a depth of access into parts of your personal self that cannot be attained any other way.

In this context, self-honesty means self-transparency—the ability to look inward to cultivate “in-sight.” Self-honesty is both a process and a skillful activity that can be learned and nurtured.

What is most essential to developing self-honesty is a courageous willingness to suspend judgment, to halt the automatic response of immediately categorizing a concept or idea according to an already existing category of what may be right or wrong, good or bad, possible or impossible.

It’s not an easy thing to do; it requires courageous willingness. Temporarily suspending your belief systems can cause you to feel uneasy, even lost. This is because most people rely on their unquestioned beliefs to try to make sense out of a world that becomes ever more unpredictable and traumatic.

Unquestioned beliefs have remarkable powers to shape our perception. What we attend to physically, mentally, and emotionally is selected and shaped to a great extent by what we unconsciously expect to experience.

To become aware of and suspend these beliefs is to invite you to look clearly and intently inside yourself as you read the words written in this article with as much courageous transparency as possible. Resist the temptation to immediately judge and classify the ideas shared before you have the chance to “try them on.”

Personal Responsibility

Personal responsibility is the continual willingness to take ownership of my personal experience. The problem I usually run into with personal responsibility is my willingness to surrender the need to be right.

The need to be right is one of our strongest and most strongly defended intentions. This is because the need to be right supports and enforces the ego-illusion that I alone am special, different, and somehow more entitled than others. It is the basis of our misguided concept of what it means to be independent.

Personal responsibility is the degree of my willingness to take both individual and collective ownership for my perceptions, thoughts, beliefs, emotions, and behaviors; my communication with self and others; all my relationships; and the conditions of my life that I am now experiencing.

This is not self-blame. To blame myself I must split myself into both; the part of me that is doing the blaming and the part of me that is getting blamed. This splitting of my self into opposing parts weakens my sense of self and distorts my perception of others.

The action of personal responsibility is looking, listening, and letting go. This is the art of surrendering.

Surrendering is the Warrior’s art. To surrender is to give in, not give up. Giving in is accepting the reality of the situation as it is without meeting my ego’s demand to be right. To surrender means, to bring my ego-perception more into alignment with my here and now, in the moment— in my body experience.

Authentic Self-Expression

Self-expression is the magic of transformation. When you become clear and open to the intuitive signals— the music of your Natural Self—you will begin to experience a deep sense of enjoyment and empowerment. Self-expression is the dance of energy and enjoyment of the Authentic Self when allowed to play.

The Authentic Self is that place of connection between mind, body, Energy in MOTION, intuition, and insight that is in a constant state of flow; it is both in the heart and from the heart. To express myself honestly and with responsibility is to engage and empower my Natural Self to create and re-create itself spontaneously in my life.

The Authentic Self is a wise, gentle, powerful, and playful being inside each of us that is usually invisible to the ego’s eye. This is mostly because the Authentic Self lives in the heart and the ego lives in the head. The Authentic Self perceives the world in terms of “us,” while the ego sees the world in terms of “me.” The Authentic Self senses connection and commonality while the ego notices separation and specialness.

Self-expression becomes the action of clearly tuning into the music of the authentic Self and allowing that music to move you moment to moment as you dance in ever-growing harmony. Self-expression is the spontaneous alignment of who you are with what you are doing.

Compassion Fatigue: Professional Risk for Counselors

Introduction

Compassion Fatigue – also known as secondary traumatic stress and vicarious trauma – is pervasive in the counseling profession; particularly with care giving professionals who have a high degree of exposure to patients who are experiencing some form of psychological, medical or social trauma and who are trauma survivors themselves. In a 2004 article called “Compassion Fatigue Following the September 11th Terrorist Attacks: A Study of Secondary Trauma Among New York City Social Workers,” it is noted that: 

“…[M]ental health professionals working with traumatized clients were at greater risk for CF, controlling for demographic factors, personal trauma history, social support and work environment factors…We suggest that the important variables in predicting CF include degree of exposure, personal history, social support, and work environment factors.”

While this article focuses on the mental health professional, I believe compassion fatigue is not exclusive to mental health professionals and is found in virtually every healthcare specialty, particularly those who engage in counseling.

Degree of Exposure

Degree of exposure to another person’s trauma may be a little more difficult to estimate than one might think. How many of our patients are trauma survivors? Which diagnostic categories are most associated with trauma? Is trauma limited to clients with a formal diagnosis of PTSD or is trauma present in other diagnostic categories such as depression, family violence, marital discord, personality disorders and substance abuse to name a few? What about social and medical trauma?

Degree of exposure may also include the nature, length, frequency and intensity of contact with trauma survivors. I recently gave a workshop on compassion fatigue to counselors working in a correctional facility. In this closed environment where the frequency and intensity of contact was high, these counselors experienced frequent symptoms that are associated with vicarious trauma such as abuse of chemicals, spending less time with clients, tardiness and absenteeism, making professional errors, being critical of others and depersonalizing clients.

Personal History

One of the questions I almost always ask in my workshops is: How many of us in the counseling profession have experienced personal trauma? The answer I hear back most often is 85%, which is actually higher than the 66% for psychotherapists as estimated by Pearlman and Saakvitne in their book “Trauma and the Therapist,” which focuses on countertransference issues in psychotherapy with incest survivors. How can a personal history of trauma place a counselor at higher risk for compassion fatigue?

In “The Body Bears the Burden” by Dr. Robert Scaer, the concept of “emotional kindling” is introduced which he describes as a: “self-sustaining feedback circuit” to explain a type of emotional “spontaneous combustion.” Those of us with a personal history of trauma may be more susceptible to spontaneous emotional combustion when working with trauma survivors, whether that is in the form of an explosion or implosion, because we have a built in, emotional hyper-sensitivity to traumatic stress; particularly if our patient’s trauma is similar to what we have experienced in our own past personal history.

Social Support

One of the first jobs I had right out of graduate school was working as a crisis counselor in a very busy inner-city emergency room. I can still recall trying to explain to my family and friends some of the experiences I had working with acutely traumatized patients and the blank look that would come over their faces or the outright exclamation that I must be mistaken or exaggerating. After a while I stopped trying to explain my experiences and would spend most of my leisure time either alone or with co-workers, as we would descend at times into dark humor about our patients.

Isolation and withdrawal from our support network is a telling sign of compassion fatigue. As we begin to unconsciously internalize the traumatic experiences of our clients, our frame of reference begins to change, from inclusion to exclusion. In a workshop I gave for outreach crisis workers that was co-sponsored by the police department, one of the officers shared that over a period of time police officers would often experience a progressive sense of isolation excluding everyone else from their circle of trust except other officers. The same is often true for counselors.

Work Environment Factors

Are there certain conditions at work that can either contribute to or help ameliorate compassion fatigue? In an unpublished report called “Vicarious Traumatization and Burnout Survey Report” Mary Louise Gould, Med., author and consultant states: “Wherever trauma work is happening, the setting itself is another crucial variable. This is true for the professional as well as for the survivor, both of whom need to feel safe and supported within the work environment.”

How often are survivor counselors attracted to work environments that may (unconsciously) resemble their family of origin? Freud said: “You will repeat instead of remember.” As I look back now I realize I should have been somewhat alarmed at the ease in which I slipped into the chaotic, unpredictable and at times even dangerous conditions that accompanied my role as a crisis counselor in an inner-city emergency department; a perfect fit for a survivor of physical and emotional abuse. My awareness was limited only by my willingness and ability to be honest with myself, to accept ownership for my thoughts, feelings and behavior and to express who I deeply felt myself to be.

Three Principles for Healing

From the forward of my book, “Breath of Relief: Transforming Compassion Fatigue into Flow,” I outline three principles that I believe are essential for healing and transformation. They are: Self-honesty, personal responsibility and self-expression. These principles will be the subject of my next article: Compassion Fatigue: Principles for Transformation.

Bibliography

Herman, Judith. Trauma and Recovery. Basic Books. New York, New York. 1992.

Keidel, Gladys Catkins. “Burnout and Compassion Fatigue Among Hospice Caregivers,” The American Journal of Hospice and Palliative Care. May/June 2002; 19(3); 200-205.

LaRowe, K. Breath of Relief: Transforming Compassion Fatigue into Flow. Sidran Press, Boston Mass. 2005

Levine, Peter. Waking The Tiger: Healing Trauma. North Atlantic Books. Berkley, California. 1997.

Pearlman, Laurie Anne and Karen W. Saakvitne. Trauma and the Therapist. W.W. Norton & Co. New York, New York. 1995.

Scaer, Robert. The Body Bears The Burden: Trauma, Dissociation And Disease. The Haworth Medical Press. Binghamton, New York. 2001.

Compassion Fatigue: The Cost of Caring

What is Compassion Fatigue?

Have you ever watched a loved one struggle with an illness? Have you ever worked with a child who was the victim of abuse at home? Have you ever had a friend who lost a son or daughter in an accident? Have you ever had nightmares or panic attacks because of all of the tragedy and violence you see in the news?

Caring for other people is part of human nature, but sometimes caring comes at a price. Even if we aren't the victims of direct trauma ourselves, we can experience and internalize it by being repeatedly exposed to the emotional shock and pain of people who are or have been victims.

Often times, we feel overcome with powerful, persistent emotions. Heartache. Sadness. Fear. Guilt. Stress. But sometimes these emotions can have physical, even psychological effects — ones that can leave our bodies, minds, and souls burned out and devastated.

If you've ever felt this way about someone else's grief, trauma, or illness, there's a good chance you're suffering from something known as Compassion Fatigue.

Compassion Fatigue is nothing less than secondary traumatic stress. It's the result of mirroring and absorbing the emotions of people who have suffered or are suffering from illness, addiction, violence, or other tragedies. Left untreated and unmanaged, it can lead to debilitating symptoms such as feeling aloof or disconnected, depression, chronic fatigue, anxiety, and insomnia.

Fight, Flight and Freeze

Compassion Fatigue is experienced as repetitive shocks to the mind and body. The sympathetic nervous system is hyper-activated, secreting large amounts of adrenaline into the bloodstream in preparation for fight or flight. The heart rate increases, breathing becomes short and shallow, blood vessels constrict and muscles tighten. The neo-cortex, the thinking brain begins to shut down in favor of the automatic responses of the more primitive, reactive Limbic system or emotional brain.

In the case of Compassion Fatigue, these repetitive shocks often occur “under the radar” of conscious awareness. When there is no specific mechanism to fight or flee the traumatic stress all the body can do is “freeze”. The freeze response is the psychological mechanism most associated with PTSD and is comparable to gunning your car engine in gear while stomping on the brakes. Repeatedly, over time your body will suffer the same fate as your car – mechanical breakdown and eventually, complete systems failure.

Wired and Tired

The new research on traumatic stress strongly suggests that the cumulative effects of this repeated freeze response is what some experts in the field are calling “energy residue.” Over time, the body becomes habituated to this condition of chronic over-stimulation and simultaneous exhaustion; a state I call “wired and tired”. As a result the body stores this energy residue resulting in greater sensitivity to stress and trauma, causing the release of more adrenaline in a repetitive emotional short-circuit.

Who Does Compassion Fatigue Affect?

Compassion Fatigue has commonly been diagnosed among health-care and medical workers (doctors, nurses, EMTs, and nursing home attendants). But it's beginning to be diagnosed and recognized among anyone who works closely in a caring capacity with people, such as: social workers, judges, lawyers, psychologists, firemen, police officers, soldiers, child custody workers, teachers, and clergy.

Compassion Fatigue also affects family care providers: those who take care of elderly parents, or disabled/sick children and spouses. The rate of Compassion Fatigue found among adults is only expected to increase as the general population continues to age resulting in family members assuming the primary responsibility of caring for their aging parents.

What Can We Do About Compassion Fatigue?

Compassion Fatigue is caused primarily by the body's inability to release stress. Trauma experienced in the mind literally becomes frozen energy in the body. To release this energy, it has to be converted to flow.

Flow is the state of mind we experience when we're in a groove, full of attention, energy, and concentration. For years, people have used techniques such as Tai Chi, Qigong (Tai Chi's early ancestor), or yoga to create flow in their lives. These techniques also work to release frozen trauma or stress in our bodies and get this trapped energy circulating throughout our bodies in the form of flow.