Understanding and Preventing Compassion Fatigue -A Handout For Professionals

Most of us became counselors because we wanted to assist others in need. Yet our capacity for compassion, along with the intensity of our work can, at times, leave us vulnerable for "compassion fatigue." This is a term that was coined to describe the set of symptoms experienced by caregivers who become so overwhelmed by the exposure to the feelings and experiences of their clients that they themselves experience feelings of fear, pain, and suffering including intrusive thoughts, nightmares, loss of energy, and hypervigilance. It can be cumulative (from the effects helping many clients) or occur in response to a particularly challenging or traumatic individual case. This extreme state of anxiety and preoccupation with the suffering of those being helped becomes traumatizing for the helper. For this reason it is sometimes called "vicarious traumatization" or "secondary traumatization"(Figley, 1995).

Who is at risk?

While our training, professionalism, and good boundaries within our helping roles are protective, really anyone with the capacity for true compassion, empathy, concern and caring is vulnerable to compassion fatigue. In other words, the greatest strength that you have to bring to your occupation- your capacity to develop a compassionate connection with your clients-is also your greatest vulnerability. Therefore, it is not a characteristic that you would choose to give up, rather it is more logical to educate yourself so you understand compassion fatigue and know what you can do if you begin experiencing symptoms. Realize that the more prolonged exposure to traumatic events you experience (working too long of hours), the more personal life demands you have, and the more isolated you become from others collectively increase your vulnerability for compassion fatigue.

Warning signs and symptoms

The symptoms of compassion fatigue are similar to those of Posttraumatic Stress Disorder, only instead of the symptoms being based upon a trauma that you directly experienced, they are due to the trauma that your client(s) have experienced. Additionally, there is a cynical, discouraged or hopeless attitude about your work or your career that begins to set in. Paradoxically, you may find it difficult to leave your work at the end of the day. You may have thoughts that preoccupy you about a particular case. Being aware of what these symptoms mean and how they are affecting you is important. You can evaluate yourself with an excellent self-assessment tool that can be found at: http://www.proqol.org/ProQOl_Test_Manuals.html. While this checklist is more comprehensive a few of the predominant symptoms of compassion fatigue are listed below:

• Feeling estranged from others (Having difficulty sharing or describing feelings with others)
• Difficulty falling or staying asleep.
• Outbursts of anger or irritability with little provocation.
• Startling easily
• While working with a victim thinking about violence or retribution against the person or persons who victimized.
• Flashbacks connected to my clients and families.
• Needing more close friends.-feeling there is no one to talk with about highly stressful experiences.
• Working too hard for your own good.
• Frightened of things traumatized people and their family have said or done to me.
• Experience troubling dreams similar to a client of mine and their family.
• Experienced intrusive thoughts of sessions with especially difficult clients and their families.
• Suddenly and involuntarily recalled a frightening experience while working with a client or their family.
• Preoccupied with a client or their family.
• Losing sleep over a client and their family's traumatic experiences.
• Felt trapped by my work as a helper.
• Felt a sense of hopelessness associated with working with clients and their families.
• Have felt weak, tired, rundown as a result of my work as a helper.
• Have felt depressed as a result of my work as a helper.
• Am unsuccessful at separating work from personal life.
• Feel little compassion toward most of my co-workers
• Thoughts that I am not succeeding at achieving my life goals.
• Feel I am working more for the money than for personal fulfillment.
• Find it difficult separating my personal life from my work life.
• A sense of worthlessness/disillusionment/resentment associated with my work.

Prevention, Resiliency and Treatment

Early recognition and awareness is crucial in being able to be resilient to compassion fatigue. Compassion fatigue is treatable! Keeping your life in balance or getting it back in balance, by taking some time off work, or enhancing your self-care are critical techniques. Keeping your body and your health in good shape is essential. You are not going to be resilient if you are not well rested. You may need medical attention if the symptoms of compassion fatigue, such as sleep disturbance, start interfering with your ability to function. If you are eating poorly and not exercising you are more vulnerable physically and emotionally to the effects of distress. Therefore, keeping a healthy balance in your life is a requirement to prevent and treat compassion fatigue. Caregivers that have a structured schedule that allow them time to organize and do good self-care are more resilient (Panos, 2007).

Another essential factor to prevent and treat compassion fatigue is to have some good relationships with either colleagues, a supervisor, or a therapist that you can safely and confidentially discuss the distresses you are experiencing. Isolation is a symptom of compassion fatigue and is ultimately dangerous. To be resilient you need to have good support and connections with others.

Many counselors report that creative therapies such as writing in a journal, or expressing their feelings through music or art are helpful. Diversions and recreation that allow you to take mini-escapes from the intensity of your work is absolutely essential- not optional as some may think. Research on resiliency in pediatric healthcare workers show that those that have the ability to "turn their thoughts about work off" are more resilient throughout their career. Sometimes this involves developing a little ritual at the end of the day to transition into your life outside of work, while leaving your cares and stresses in the workplace (Panos, 2007).

What to do if you have symptoms of Compassion Fatigue:

• Have a recognition and awareness of the symptoms of compassion fatigue in yourself.
• Restore a healthy balance in your life, including good sleep, good nutrition and exercise.
• Get medical treatment for those symptoms that are interfering with your daily functioning.
• Utilize your positive supportive connections with others to process your feelings.
• Implement regular mini-escapes in your life, like recreation, creative therapies or other healthy diversions from the intensity of your work.
• Don't medicate yourself with drugs or alcohol! Don't use other self-defeating addictions! Get professional help for yourself if needed to get back on track.

Conclusion

Unrecognized and untreated compassion fatigue causes people to leave their profession, fall into the throws of addictions or in extreme cases become self-destructive or suicide. It is important that we all understand this phenomenon for our own well-being, but also for our colleagues. If you notice a colleague in distress- reach out to them. Give them this article and let them know you care and are available to talk if they need.

Angelea Panos, Ph.D. is a therapist that specializes in trauma and grief, she has 20 years of experience in helping survivors. She is a board member of Gift From Within.

Websites with information or resources on Compassion Fatigue

Gift From Within-PTSD Resources- www.giftfromwithin.org

DVD When Helping Hurts: Preventing & Treating Compassion Fatigue- http://www.giftfromwithin.org/html/video4.html#4b

http://www.proqol.org/ProQOl_Test_Manuals.html.

Green Cross Foundation. www.greencross.org

References and Suggested Reading:

Boscarino, J. A., Figley, C. R. and Adams, R. E. (2004). Evidence of Compassion Fatigue following the September 11 Terrorist Attacks: A Study of Secondary Trauma among Social Workers in New York. International Journal of Emergency Mental Health, 6:2, 98-108.

Figley, C.R. (1982). Traumatization and comfort: Close relationships may be hazardous to your health. Keynote presentation, Families and close relationships: Individuals in social interaction. Conference held at the Texas Tech University, Lubbock, March.

Figley, C.R. (1993a). Compassion Stress: Toward Its Measurement and Management. Family Therapy News, February, 1-2.

Figley, C.R. (1993b). Compassion Fatigue and Social Work Practice: Distinguishing Burnout from Secondary Traumatic Stress. Newsletter of the NASW Florida Chapter, June, 1-2.

Figley, C.R. (Ed.) (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. An Overview. 1-20. New York: Brunner/Mazel.

Figley, C. R. and Roop, R. (2006). Compassion Fatigue in the Animal Care Community. Washington, DC: The Humane Society Press.

Panos, A (February, 2007). Promoting resiliency in trauma workers. Poster presented at the 9th World Congress on Stress, Trauma, and Coping, Baltimore, MD.

Pines, A. & Aronson, E. (1988). Career burnout: Causes and cures. New York: Free Press.

Saakvitne, K.W., Gamble, S.G., Pearlman, L.A., & Lev, B.T. (2000). Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran Foundation and Press.

Seligman, M. E. P., Steen, T. A., Park, N. & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60:5, 410-421.

Solomon, Z. (1993). Combat Stress Reaction : The Enduring Toll of War. NY: Springer.

Copyright 2007 Gift From Within- a non-profit organization serving PTSD clients and professionals. Website: www.giftfromwithin.org