And nurses, counselors, therapists, caregivers, social workers, case managers, community health workers, teachers, first responders, peer outreach… in short any person who spends their time (work or volunteer) opening themselves to the experiences of others’ suffering. In a recent continuing education exercise, I was asked to examine myself for resilience and potential risk of compassion fatigue. The simple act of participating in the exercise and completing the assignments for the course reminded me of the very great risk that people in caring roles face of suffering from the “cost of caring.” Amy Cunningham speaks of this beautifully and concisely in a Ted Talk, describing what this cost can be and toll it takes (link in the credits below, totally worth the viewing).
Many of us who work and volunteer in roles of service have adopted the philosophy that self-denial in pursuit of career, advancement, and the care of others is to be admired. Self-sacrifice is applauded and rewarded. Going above and beyond is the expectation. Adding insult to the expected self-injury is that we are frequently also required to be above the consequences or be able to physic our own resulting ailments. To a certain extent, I can agree with admiring dedication and industry. A good work ethic is absolutely to be admired. However, there is a fine line between a good work ethic and good self-care. I occasionally use that line as a jump rope (more about that later). For those of you in the caring professions, and a few of you who are not, you have likely heard the term “compassion fatigue.” You may also have heard this described as secondary traumatization or vicarious trauma. What many people think of when folks talk about stress related to caring for others is burnout. I want to tell you now, that these are different concepts, related but decidedly not the same.
As caring professionals, we frequently are exposed to the traumatic experiences and information that can be shocking, depressing, or even devastating just being exposed to it, hearing it, visualizing it, and empathizing with the victims in our care. Empathy is one of the most important tools of the caring professions, but there is a cost involved in being empathic day after day. Repeated exposure or even just one event that triggers some recognition or identification becomes a lived sensory experience that transports the care giver into the realm of the victim. Some professionals begin experiencing symptoms of traumatic stress, much like those of the people who have been involved in critical incidents or crises. Different than counter-transference where the experience mirrors or parallels experiences from their own lives or triggers emotional reactivity in the part of the caregiver because of personal history, they respond with stress related symptoms purely out of empathy for the situation of those they assist. The frequency or intensity of just experiencing the trauma through the eyes of the individual they are helping is sufficient to trigger signs and symptoms. This is compassion fatigue. It is not my intent in this post to give all the specific signs and symptoms of traumatic stress, but in broad strokes, it has physical, cognitive, behavioral, emotional, and spiritual impact. It can impact relationships. It can impact efficacy as a professional.
Ok… I hear you saying, “but that sounds a lot like burnout.” Here is the most significant difference: Victims of burnout have gotten to the point that they just want to give up. They have nothing left to give, no space to absorb. They have exhausted their energy, empathy, and passion, like a bulb that was used until failure or a battery run past minimum charge. The way most experts in this topic differentiate between compassion fatigue and burnout is that people who have gotten to the point of burnout frequently no longer want to practice their profession or calling. While compassion fatigue results in risks for the professional and their clients due to potential boundary concerns and difficulty managing the stress they experience, burnout can lead to the loss of empathy and resentment towards those for whom they once cared. Professionals and volunteers with burnout can become callous and appear uncaring or harsh. It can result in errors of omission in services rendered and potential harm to patients or clients.
The important piece of this puzzle is that neither of these conditions are unavoidable. Taking the appropriate actions in self-care, consultation, and support can provide preventative measures to avoid the pitfalls of vicarious trauma and even help bring caring professionals back from the brink of burnout.
Insight into your own needs and responses can be the best preventative measure. Watch for your own signs of drowning: Irritability, sleeplessness, dread going on shift, numbness to any and all emotional content (personal or professional), rumination and inability to let go at the end of the day, fatigue, isolation, using (or abusing) alcohol or drugs… You know your own signs best. Self-awareness is the best primary defense, but when we fail to see our own symptoms, it is good to have the buddy system. Friends, family, colleagues are often great at noticing when you are “not yourself.”
Over the years, I have gotten to be much better at spotting my own particular signs of distress (and knowing how to combat these signs). When my natural defense system is on emotional overload, I fall back on my introversion and a combination of task and avoidance oriented coping (You thought task and avoidance would be mutually exclusive, didn’t you?). When I start running a tad low, I tend to become more task-oriented, workaholic, and isolating. I avoid situations and people that require my emotional presence. I tend to shut people out if it isn’t work related, and I let things go that are my best forms of self-care: Running, gym time, sleep, meditation, and play… yes play. Adult or not, we all need recreation. It helps us rejuvenate our cognitive processes. But when I’m overdrawing my emotional and empathic accounts due to work or personal stressors, these self-care processes always seem to be the first to go. I know myself well enough (after, the unspecified number of years I will admit to being on the planet) that I recognize when things in my life have gotten out of hand and I have reached that aggregate limit. When this happens, I try to fill my time and avoid any activities that might let my mind drift to the very topics or memories that hurt… and yet theses topics and memories are likely the very ones that probably need most to be taken out, examined, and processed. With that self-awareness, I also know that timing is key. If I push myself too soon, it doesn’t serve the best purpose, but if I leave it too long, my self imposed exile becomes way to comfortable and I won’t want to rejoin the world. This is where that support network comes in handy. Friends and colleagues who know me best are also the best at dragging me back out of any caves I might crawl into and encouraging the self-care I’ve probably been neglecting.
For you, my readers, I encourage an honest self examination and evaluation. Be ruthless. Be thorough, and try to recall how you handle critical events and times of intense stress. Evaluate time and outcome. How did it work? List the coping strategies that you have in your toolbox, and objectively determine whether they are truly helpful or maybe not so much.
Prevention is a keystone to good health and good mental health. Restorative and preventative exercises can divert compassion fatigue from become burnout. It is important to get rest, exercise, nutrition, and time away from constant exposure to shared trauma and the histories that recount horrific occurrences. Most jobs and deployments have leave or paid time away. It is there for a reason. Take a break. Use that time. Most importantly, it is crucial to have appropriate training, refresher courses, supervision, and/or consultation. Carrying the burden can get extra heavy, and consultation (or supervision) provides ethical opportunities to identify and address challenging aspects of situations that may trigger stress. It is important to employ your ethical decision making model and engage with colleagues who can be objective and provide good clinical counterpoint. Professional colleagues can often provide support to each other and offer insight when we get overwhelmed in our own empathic response.
Lastly, I would encourage those of you out there caring for others to remember your own natural supports: Family and friends. We often have to be concerned with confidentiality, and we also wish to protect the ones we love from some of the things we see, hear, and experience. However, don’t shut them out. You need not share details of information gained under the cloak of privacy and confidentiality (or when the story is just too terrible), but you can share your own feelings and fears. You can explain your own reactions without having to give details of the stimuli. Stay connected to humanity, especially your own. That can give you a life jacket to prevent drowning in empathy, and regardless of the proverbial command in the title, it is completely unnecessary to heal yourself.
Amy Cunningham presents on Ted Talks, Drowning in Empathy. http://edu.ava360.com/drowning-in-empathy-the-cost-of-vicarious-trauma-amy-cunningham-tedxsanantonio_d7a4359c8.html