Wednesday, November 8, 2006

Compassion Fatigue

Last week we talked about Caregiver Stress and Strain, which focused on someone who is caring for a loved one.  This week let's talk a little bit about Compassion Fatigue, which is focused on people who work in the helping professions. 

Compassion Fatigue is a concept that has been around for awhile, but seems to be more accepted and recognized as a valid danger for people who work in the helping professions.  Some may be more familiar with other terms such as Vicarious Trauma, Grief Overload or Secondary Traumatic Stress Disorder.  The definition for Secondary Traumatic Stress Disorder is "the state of tension and preoccupation with the individual or cumulative trauma of clients as manifested in one or more ways including reexperiencing the traumatic event, avoidance/numbing of reminders of the event, and persistent arousal."  Some at risk professions are Emergency Care Workers, Counselors, Mental Health Professionals, Medical Professionals, Clergy, Volunteers and Human Service Workers.  Even people who aren't in the helping professions can fall prey to Vicarious Trauma through the daily intrusions of the media regarding violent crimes and traumatic events.  By being constantly subjected to these images, it can create a persistent arousal state within us and we may not even be aware that it is happening.  Some examples are being an overly protective parent, a hypervigilant female, or the complete inability to trust people. 

The symptoms of Compassion Fatigue are important to discuss, because a lot of them are symptoms that people can experience on a daily basis and just explain them away as being due to the stress of daily living.  However, if you are in the helping profession please be aware that if you have these symptoms, these are warning to practice self-care and prevent burn-out.  The symptoms can be found in these seven areas, Cognitive, Emotional, Behavioral, Spiritual, Personal, Physical and Professional.  Let's discuss some of the more common symptoms in each category.

Cognitive:  We  may begin to feel apathetic about our work, clients or patients.  We may become preoccupied with the disease process, illness or trauma.  Professionals often talk about the occupational hazards of working in the health field.  For example, it is common to hear someone saying they have a pain in their abdomen and they are convinced it's cancer because a client of their's had similar symptoms and that's what they were diagnosed with.  We can live in perpetual fear of what's going on in our body and can begin to question the medical community if we perceive they are not on top of their game. 

Emotional:  Anxiety, depression or overly sensitive.  We may become guilty because we feel we should have or could have done more for our client/patient.  We may become shut down where our patient's and their families can no longer elicit emotional responses from us.

Behavioral:  Irritable or sleep disturbances.

Spiritual:  We can start questioning the meaning of life and our religious beliefs.

Personal:  We can become withdrawn from our loved ones, and have decreased intimacy with our significant others.  This may be done in an effort to not become emotionally available to anyone, or we have given so much of ourselves through work that we have no more to give to our family.  We may become intolerant of others.  We may become overprotective parents.

Physical:  We may have a lowered immune system because of the stressors we encounter on a daily basis, and much like Caregivers, people in the helping profession usually sacrifice their own needs for the needs of others.

Professional:  Our work may suffer because we have low morale, low motivation, staff conflicts, unusual or high absenteeism, fatigue and irritability.

So it's easy to see how mundane some of these symptoms can be, so it's particularly important for us to pay attention to these symptoms, especially if they are compounded.  One way to keep track of how we are doing in our work is by doing check-ins with ourselves.  There are several tests out that very quick and easy that one can take to see if they are in danger of Compassion Fatigue, or worse - Burnout.  These tests can be found on-line.

The Compassion Fatigue Self Test - can be found at  It's a simple, ten minute test that will rate your level of Compassion Fatigue and your risk for Burn-out.

The Compassion Satisfaction and Fatigue Test - can be found at  Even though this test has been simplified, it is a little more time consuming, but it will not only rate your level of Compassion Fatigue and Burnout, but also assess your current satisfaction with continuing in the helping profession.

The Caregiver Strain Index - can be found at  This is a simple test that is used by Caregiver's but it has the same principles for knowing your level of Compassion Fatigue.  I call it the quick and dirty test to do an occasional check-in.

Now the next thing is you know if you are in at risk category, you know the symptoms you may have, you know how to evaluate yourself to see if you are heading into trouble, but what can you do prevent it?  You have to practice self-care.  We all know this, however it is easier said than done.  I realize this, but seriously - if you want to continue to help people and do the good work that you do, then it is necessary and vital that you take care of yourself.  The first lesson is to practice saying "no."  People in the helping profession have a very difficult time with this.  You may  find it easier to start practicing saying "no" on family members or friends.  You also have to find what is meaningful to you.  Develop your own self-care plan.  What will your plan contain?  You  have to develop the same coping strategies that you would if you were suffering the loss of a loved one.  One of the main tenets for coping strategies in grief, is the value of the support system.  So what are your supports?  I have an earlier blog that can help with this is more detail, but if you are in the helping profession, what about your work environment or agency - use them as your supports.  Who will better understand the pressures you are under at work, than a peer or supervisor? 

Here are some other key strategies that you may find helpful:

Know your own triggers and areas of vulnerability.  Learn how to avoid them and diffuse them.  For example, if your case involves a terminally ill child that is similar in age to one of your own children, then you know that this case may be an emotional trigger for you.  What are your alternatives in dealing with this and preserving yourself?  Can another professional handle the case?  Can you talk to your supervisor about your concerns?  Can you summon a strong support system to help you through the case?  It's important to explore and discuss your options.  You don't have to tackle this alone.

Allow yourself to grieve.  People in the helping profession are expected to respond to the human loss, emotion and tragedy that surrounds them everyday as part of their work, but they are not expected to react as a human.  Impossible!  The fact is there will be clients you become attached to, there will be clients you lose, there will be clients that you grieve their loss.

Set boundaries for yourself.  Boundaries are in place as protective measures.  It is very common to have the boundary line blurred from time to time when you are working in the helping profession, that is only natural, but learn to recognize when you are getting ready to cross the line and why - this will help you keep those boundaries in place in future situations.

Alter irrational beliefs.  There are many different reasons why people are drawn to the helping professions.  A lot of us are perfectionists and don't want to be judged.  We need to know that we can't do it all and we don't have all the answers.  Replace your irrational beliefs with affirmations, such as "I am capable," "I am competent," or "I am good." 

If you still need convincing that you need to take the time to practice self-care, there are a lot of sites on the Internet regarding this topic.  Please explore them and convince yourself that you need to fit yourself in to your schedule in order for you to continue doing the good work that you do for your patients, clients and the community.

Until next week, please be gentle with yourself.


P.S.  If you have found this posting or previous postings helpful, please consider making a donation to The Bereavement Center.  We are a non-profit organization that serves the community, and we operate solely on donations from families, clients and the community.  As always, your donation will be greatly appreciated and acknowledged.

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