Many people are motivated to work in the helping professions because they relate in some way to the populations they work with.
But when identifying with that person goes too far or takes a turn, a caregiver can experience that person’s suffering.
Since the early 1990s, this has been referred to as compassion fatigue or vicarious/secondary trauma. Dr. Charles R. Figley, one of the founders of the traumatology field, called it “the cost of caring for others in emotional pain.”
This is not just burnout or simple caregiver fatigue; it’s about a caregiver experiencing trauma while witnessing another’s physical, emotional, or spiritual pain.
Concept pioneers McCann and Pearlman define it as “a process through which the caregiving individual’s own internal experience becomes transformed through engagement with the client’s trauma” (1990).
Looking over these descriptions and definitions, we can see how the concept may interfere with our ability and best intention to maintain our professionalism. This article is intended to raise awareness about the topic; to look at some symptoms that may indicate that compassion fatigue is happening to you, a colleague, or family member; to list a series of risk factors that may raise the likelihood of compassion fatigue occurring; to share some strategies for dealing with it; and to offer resources.
According to the Compassion Fatigue Awareness Project, studies suggest that anywhere from 25–50 percent of health care workers experience symptoms of compassion fatigue. Everyone from lawyers to long-term care workers, family caregivers to child protective services workers, emergency room nurses to police officers may find themselves dealing with this issue.
Many may think it’s normal or just “goes with the territory,” but that is not the case. If it is left ignored or if professionals are not aware of the possibility of compassion fatigue, outcomes can range from angry outbursts to clinical depression to development of medical problems (e.g.; diabetes, COPD, heart disease, high blood pressure) and workplace effects such as absenteeism, low productivity, and staff turnover—all of which can compromise the quality of care a professional and an organization provide.
So what symptoms should one look for as possible indicators of compassion fatigue? “A recently published Canadian study in the Archives of Internal Medicine by Leeat Granek found that half of oncology doctors reported feelings of failure, self-doubt, sadness, and powerlessness
as a result of grief from their jobs. A third talked about guilt, loss of sleep, even crying
” (Smith, 2012b). The literature also frequently mentions things like:
- Reduced sense of efficacy on the job
- Concentration difficulties
- The perception that obligations outweigh your resources
- Apathy and emotional numbness
- Secretive addictions and self-medicating in a variety of ways
- Isolation and withdrawal
- Intrusion symptoms in thoughts, dreams, or nightmares
- Bottled-up emotions
Those affected are often the last to recognize what’s happening and may need others to help them realize it. These types of symptoms, closely resembling those of post-traumatic stress disorder
, could surely affect our ability to rationally detach in the midst of a crisis, as well as our ability to function in our day-to-day routines. And as multiple employees in the same organization experience these symptoms and feed negatively off one another, a toxic culture can result.
So who’s at risk for compassion fatigue? Experts say those most likely to experience it include:
Those new to the field of caregiving.
Unlike burnout, compassion fatigue happens more quickly. New caregivers may be more likely to get overwhelmed by their responsibilities.
Those with a history of personal trauma.
Abuse, natural disasters, military experience, dealing with the unexpected death of a loved one, accidents, neglect/abandonment—just to name a few.
Professionals with large caseloads.
The greater the number of clients, the greater the likelihood that you’ll have one or several clients experiencing or having experienced traumas that you’ll be exposed to.
Professionals working long hours.
Twelve- and 24-hour shifts are sometimes the norm in the helping professions; many human services professionals work a great deal of overtime and are asked to pull double shifts regularly. Many are also caregivers of some sort in their personal lives.
Those with a history of experiencing burnout.
Job dissatisfaction built up over time becomes its own form of trauma and may reflect a lack of coping skills.
Those who have trouble communicating.
Lack of ability to express oneself clearly or to listen effectively could be contributors to experiencing trauma.
Professionals with inadequate personal support systems.
We all need others to lean on and help us when the going gets tough—a significant other, family, friends, neighbors, trusted colleagues, church groups, clubs, pets, etc.
Strategies for Dealing With It
So now that you know a little more about what compassion fatigue is, what can lead to it, and how it might manifest in professionals, what can you do about it? How do you prevent and manage it?
Training and workshops to raise awareness about it are certainly one way. CPI’s advanced course for Nonviolent Crisis Intervention®
Certified Instructors on the topic of Trauma-Informed Care addresses the topic. Additionally, any Nonviolent Crisis Intervention®
Certified Instructor can easily make a natural connection to the topic when teaching about the concepts found in Unit 5 of the course curriculum: Precipitating Factors, Rational Detachment, and the Integrated Experience.
Managers, administrators, and human resources professionals can encourage and stimulate conversation about the subject via bulletin boards, staff meeting discussions, and/or coaching/supervision sessions. Formal debriefing sessions, internal support groups within an organization, Employee Assistance Programs, and corporate wellness programs/committees are other opportunities for raising awareness and helping those who are experiencing compassion fatigue.
The Caregivers’ Bill of Rights
[PDF], The Ten Laws Governing Healthy Caregiving
[PDF], The Ten Laws Governing a Healthy Workplace
[PDF], and The Ten Laws Governing Authentic, Sustainable Self-Care
[PDF] found on the Compassion Fatigue Awareness Project website make for great postings and discussions.
For many of us in the helping professions, we excel at taking care of others—but we sometimes put ourselves last on the priority list. Self-care is critical if we want to have enough mental and physical energy in the tank to be able to take good care of others and maintain our professionalism. That means getting adequate sleep, proper nutrition, and routine exercise—as well as partaking regularly in activities we enjoy, building and maintaining a good support system for ourselves, and pursuing a good work/personal life balance.
Job sharing or flex hours, among other supportive policies and procedures for employees within an organization, could help with that balance too. We all have a responsibility to self-monitor and to take appropriate action if we notice warning signs.
Resources and References
If you want to learn more about this topic and help raise awareness among your colleagues about it, check out the following resources.
Originally published in the Journal of Safe Management of Disruptive and Assaultive Behavior, Fall 2013. © 2013 CPI. Certified Instructors, log in to read more JSM articles.
- Compassion Fatigue Awareness Project’s websites, compassionfatigue.org and healthycaregiving.com.
- Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized by Charles R. Figley, Ph.D.
- Compassion Satisfaction: 50 Steps to Healthy Caregiving by Patricia Smith
- CPI. (2012). Instructor manual for the Nonviolent Crisis Intervention® training program. Milwaukee, WI: Author.
- Figley, C. R. (Ed.). (1995). Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Taylor and Francis Group.
- Gift From Within’s Article Library on Compassion Fatigue
- McCann, I. L., & Pearlman, L. A. (1990). Vicarious Traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131–149.
- Professional Quality of Life Scale (a measurement of the effects of helping others who experience suffering and trauma with sub-scales for compassion satisfaction, burnout, and compassion fatigue)
- Smith, P. (2012a) Alleviating compassion fatigue before it drags down productivity [PDF]. Long Term Living.
- Smith, P. (2012b) Nursing home employees often suffer from compassion fatigue [PDF].
- To Weep for a Stranger: Compassion Fatigue in Caregiving by Patricia Smith
Images: Ron Chapple Stock and michaeljung — Thinkstock