UNDERSTANDING COMPASSION FATIGUE

What is Compassion Fatigue?

Compassion fatigue is described by Figley (1995b) as a state of tension and preoccupation with the individual or cumulative trauma of clients manifested in one or more ways: that of re-experiencing the traumatic event, avoiding, numbing or reminders of the traumatic event and through persistent arousal. He also points out that when the professional is suffering trauma, as opposed to burnout, he usually experiences a faster onset of symptoms and faster recovery from the symptoms. Compassion fatigue is a state of exhaustion and dysfunction; biologically, psychologically and socially. It is a result of prolonged exposure to compassion stress (Figley, 1995b).

Symptoms of Compassion Fatigue

• Figley (1995b) believe that the ability to empathize is a key personality characteristic for effective counselling, but it also plays a vital role in the development of compassion fatigue. He asserts that empathy presents us with a paradox: it is required by counsellors to provide care and support to clients, however by having an emotional connection to someone increases the counsellor’s vulnerabilities to symptoms of compassion fatigue.
• Herman(1992), describes a type of victim-blaming that sometimes occurred in trauma workers because they themselves felt victimized by their clients whom they perceived to be threatening, manipulative, or exploitative. Clearly, this will have had detrimental effects on the therapeutic process.
• Crothers (1995) supported this debate by reiterating the responses of staff who worked with survivors of trauma, anger, sadness, caution, vigilance, sleeplessness, intolerance, nightmares, compassion, irritability, sensitivity, denial and understanding formed part of the spectrum of responses that was explored. A sense of helplessness, confusion and isolation from supporters ensues. A pattern of tiredness and emotional depletion from too much caring and too little self-caring, emerge. The symptoms are often disconnected from real causes and the symptoms triggered by past or current traumatic experiences.
• The symptoms of compassion fatigue comprise seven categories: emotional, cognitive, behavioural, spiritual, personal relations, somatic and work performance (Figley, 1995b).
• The following are some of the signs and symptoms that have been documented from research (Panos, 2008):
• 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 were victimized.
• Flashbacks connected to clients and families.
• Needing more close friends. Feeling there is no one to talk with about highly stressful experiences.
• Working too hard.
• Frightened of things that traumatized people and their family had mentioned.
• Experience troubling dreams similar to the clients and their families.
• 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.
• Feeling trapped by trauma work.
• Feeling a sense of hopelessness associated with working with clients and their families.
• Feeling weak, tired, rundown as a result of work.
• Feeling depressed as a result of work.
• Trauma counsellors are unsuccessful at separating work from personal life.
• Feel little compassion toward most of their co-workers.
• Thoughts that one is not succeeding at achieving one’s life goals.
• Feel I am working more for the money than for personal fulfillment.
• Finding it difficult to separate personal life from work life.
• A sense of worthlessness/disillusionment/resentment associated with work.

Causes of Compassion Fatigue

A key variable in the development of compassion fatigue is the counsellor’s level of exposure to traumatic material. This phenomena was explored by Dutton and Rubinstein (1995). They further expounded that the novice trauma worker may have felt especially guilty when the survivor re-experienced the trauma through necessary interviews or therapeutic intervention procedures (Dutton and Rubinstein, 1995). Pearlman and Saakvitne (1995a) assert that the cumulative effect of story after story, client after client, day after day can become a chronic condition.

According to Figley (2002), the best counsellors are the most likely victims. Figley’s experience with compassion fatigue emerged during his acquaintance with war veterans and the experience left an indelible impression on him. Furthermore he felt incapacitated at times. He experienced intensive nightmares and became obsessed by them. This led to feelings of anger and frustration over his client’s experience. This experience sparked his entry into the research and development of models in the field of compassion fatigue. Since he endured the effects from an ethnographic assimilation of the traumatic effects in his life, through secondary traumatization.

Compassion fatigue develops as a result of the caregiver’s exposure to the patients’ experiences combined with their empathy for their patients. Compassion fatigue is sudden and acute. These findings, following the Omagh bombings, revealed that in the first year (August 1998 to August 1999) there were increases in compassion fatigue scores. The researchers concluded that many of the strategies used by the mental health workers, were the same sort of strategies recommended for clients. This involved taking care of oneself through exercise and healthy living, expressing emotions and getting support (Collins and Long, 2003a). Subsequently, in order for trauma treatment to be effective, the counsellor responsible for helping the client through this process needed to re-experience the traumatic incident with the client.

This process of repeated exposure to the trauma involved an intrinsic risk of emotional, cognitive and behavioural changes in the clinician (Bride, Radey and Figley, 2007). The risk of compassion fatigue was one of the residual effects of working in a trauma unit, that is highlighted in future chapters. (Bride et a The vulnerability to compassion fatigue is attributed to the fact that therapists and trauma workers are constantly surrounded by traumatized individuals and trauma (Figley, 1995b). According to Figley (1995b), empathy is one of the major resources for trauma workers to help clients. It is also the key variable in the transference of traumatic material from the client to the therapist.

Furthermore most trauma workers experienced a traumatic event in their lives. Peeke, Moletsane, Tshivhula and Keel (1998) substantiated this statement by highlighting the plight of the social workers who live and work in a traumatic environment and are constantly exposed to some aspect of trauma directly and indirectly. Unresolved traumatic experiences may be activated by similar experiences of clients and this is inevitable in the context of these trauma workers (Peeke et al., 1998).

The effects of Compassion Fatigue

In the aftermath of the 9/11 terror attacks in the United States of America, psychologists and other helpers were forced to balance demands placed on them in their work with patients and clients against the demands in their own lives. There was a national feeling of fear, vulnerability, and uncertainty (Saakvitne, Stamm and Barbanel, 2001). The counsellors and psychologists found their own anxieties mirrored or increased by the concerns and feelings they heard, expressed by their patients or clients and this contributed to feelings of apprehension and their own mortality.

All of the following are normal responses to exposure from secondary trauma and can influence professional work. It is therefore necessary to recognize and understand them in order to address these issues constructively. Absences from clinical practice for personal need or professional demands, which can increase the stress of clinical work, intrusive imagery such as reactions to the sound of planes or to the sight of towers are common responses after a traumatic event. Emotional reactivity involving more or stronger feelings and unexpected emotions or reactions; fear and anxiety were personal reactions to terror and threats that distract or inhibits one; fatigue in terms of emotional and physical exhaustion or weariness; and sadness, grief, or depression were acknowledged in the research as being potent effects of compassion fatigue (Saakvitne et al., 2001).

According to Figley (2002), hearing about past trauma can trigger haunting memories from a therapist’s own past. A clinician whom he worked with, related an incident of becoming angry with a client who was an adult survivor of childhood sexual abuse. The provider was surprised by those feelings, but as she considered them she realized that the therapy had forced to the surface her own buried anger towards an adult relative who had once fondled her when she was a child (Figley, 2002). Figley (2002) bases his research on his experience with treating mental health professionals. He believes that the providers more likely to suffer from compassion fatigue are those who are caring and empathetic. The stigma attached to too much empathy, caring and compassion prevent many professionals from seeking help (Morrison, 2007).

Elements of Compassion Fatigue

• Exposure to suffering, empathic responses and concern snowball towards the first stage of compassion fatigue, which represents Empathic Response. In the next step empathic response together with detachment and a sense of satisfaction escalate into Residual Compassion Stress.
• As the effects of a traumatic event gain momentum, residual compassion stress together with prolonged exposure to suffering, traumatic memories and other life demands culminate into Compassion Fatigue (Figley, 2001). The process of compassion fatigue is not clusters of isolated events but it is a blend of all the categories and effects as well as its impact on these categories. It is a recursive process and information is continuously being fed into the individual’s system. This form of negentropy helps to create a context for the individual to think about a change in the system.
• Prolonged exposure to traumatic material leads to secondary traumatic stress and this is a recursive process. Secondary traumatic stress can also prolong the exposure to traumatic events and this would then result in compassion fatigue. The single criticism that I have with this model is that it moves in a single direction, and should be bi-directional as information is continuously been fed into the system in order to culminate into compassion fatigue.

Model for Preventing Compassion Fatigue

Personal trauma had been considered by some to be more harmful to the counsellor’s psychological well-being than work related trauma, and its effects may lead to compassion fatigue symptoms being experienced. Subsequently a multi-dimensional framework based on the ecological model indicate primary, secondary and tertiary intervention to be implemented by organizations to comprehensively address compassion fatigue and burnout in trauma counsellors.

In relation to an ecological approach, primary interventions have a long term social change when implemented resulting in elimination of the root causes. Secondary interventions consisted of environmental and personal planning for the preparation in coping with the impact of secondary traumatic stress. Tertiary interventions were crisis interventions for individuals and their communities in order to reduce the long term effect. However in order for an ecological model to be effective, it must be consistently maintained on a primary, secondary and tertiary level.

Recommended Interventions for Compassion Fatigue

Directors and supervisors of trainees should consider workload, additional duties outside the clinic, and outside stressors on the trainees. Pre-professionals are not in a position of power and may be reluctant to advocate for needed cultural changes within institutions. Administrators should also consider implementation of rotations, access to additional benefits, and advocacy efforts as part of their roles.

As a first line of defense for CF, prevention is the primary recommendation. In line with this, psychologists who work with individuals exposed to trauma should continuously self-monitor for CF symptoms. Ideally the organizations they work with will provide regular education and training regarding the importance of building a self-care routine. Many clinics that provide services to traumatized populations already incorporate these elements into their sites. However, the organization should continuously monitor the need for additional supports for whom they are training.

Clinicians may use a variety of evidenced-based practices to assist psychologists who present with symptoms of CF. Cognitive-behavioral therapy and acceptance and commitment therapy have a strong evidence base in treating symptoms related to stress, posttraumatic stress, depression, anxiety, and occupational. The main aims in treating CF can be broadly considered in the following dimensions: awareness of CF, identification of current self-care, problematic thinking and behavioral patterns, skill building, barriers and problem solving, and planning ahead.

• Prevention is a first line of defense to CF. Psychologists who work with individuals exposed to trauma should continuously monitor themselves for CF symptoms and encourage others to do the same.
• Lack of awareness of CF. As CF is not an official psychiatric diagnosis, a lack of awareness can lead to development of more serious psychological symptomatology.
• Pre-professionals and early career professionals have unique risks. Graduate students, interns, and early career professionals are often managing numerous demands on a tight timetable with few resources.
• Psychologists have an ethical imperative to advocate for culture change. As psychologists, we have the power to advocate for those in training, and to create a culture where education, self-care, and well-being promotion are celebrated.
• Clinicians should carefully consider diversity and individual differences related to self-care. When implementing coping skills with a client, consider the client’s diversity factors including intersectional identities and spiritual connectedness, socioeconomic status, social supports, and current resources related to time, insurance, and access to transportation.

Compassion Fatigue Test

This compassion fatigue test will help measure if you’re suffering from caregiver burnout. Compassion fatigue is a form of burnout where caregivers continue to give themselves fully to the person they are caring for, finding it difficult to maintain a healthy balance of being able to separate themselves from the patient (empathy and objectivity).

Answering “yes” or “no” to the following nine statements will help you assess your risk for compassion fatigue.

1. Personal concerns commonly intrude on my caregiving role.

true

false

2. Family members, friends, other caregivers seem to lack understanding.

true

false

3. I find even small changes enormously draining.

true

false

4. I can’t seem to recover quickly after association with daily trauma or a troubling event.

true

false

5. Association with any type of traumatic or troubling event affects me very deeply.

true

false

6. My patients’ stress (the person you care for) affects me deeply.

true

false

7. I have lost my sense of hopefulness.

true

false

8. I feel vulnerable all the time.

true

false

9. I feel overwhelmed by unfinished personal business.

true

false

---

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